Provider Demographics
NPI:1649901018
Name:SOUSA, ERICA D (LMT)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:D
Last Name:SOUSA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PERKINS LN
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1013
Mailing Address - Country:US
Mailing Address - Phone:508-441-2824
Mailing Address - Fax:
Practice Address - Street 1:30 CORNELL ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1751
Practice Address - Country:US
Practice Address - Phone:508-441-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16595225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist