Provider Demographics
NPI:1184054561
Name:DIBERT, ERIKA (PTA)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:DIBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SAINT PARIS PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1226
Mailing Address - Country:US
Mailing Address - Phone:937-399-8131
Mailing Address - Fax:937-398-0606
Practice Address - Street 1:1600 SAINT PARIS PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1226
Practice Address - Country:US
Practice Address - Phone:937-399-8131
Practice Address - Fax:937-398-0606
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07319225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant