Provider Demographics
NPI:1457805293
Name:SKRETTINGLAND, ERIN C (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:C
Last Name:SKRETTINGLAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-7720
Practice Address - Fax:951-698-7451
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA230695Medicare PIN
CACA230696Medicare PIN
CACA230699Medicare PIN
CACA230697Medicare PIN
CACA209219Medicare PIN
CACA230698Medicare PIN
CACA230700Medicare PIN