Provider Demographics
NPI:1255990487
Name:TROUT, ERIKA JO (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:JO
Last Name:TROUT
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:JO
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 E TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8213
Mailing Address - Country:US
Mailing Address - Phone:570-977-4408
Mailing Address - Fax:
Practice Address - Street 1:1671 ROUTE 209
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7773
Practice Address - Country:US
Practice Address - Phone:570-402-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0070862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer