Provider Demographics
NPI:1700693561
Name:MADER, ERICK
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:MADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1553
Mailing Address - Country:US
Mailing Address - Phone:724-258-6211
Mailing Address - Fax:724-258-6225
Practice Address - Street 1:WILLOWPOINT PLAZA SUITE 110
Practice Address - Street 2:800 PLAZA DR
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:724-379-7130
Practice Address - Fax:724-379-7178
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist