Provider Demographics
NPI:1023501871
Name:ANDERSON, ERIN MICHELLE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 PERRY DR APT E
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-4175
Mailing Address - Country:US
Mailing Address - Phone:307-575-1932
Mailing Address - Fax:
Practice Address - Street 1:162 1ST ST BLDG 1402
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-4316
Practice Address - Country:US
Practice Address - Phone:805-982-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant