Provider Demographics
NPI:1750419081
Name:BAUMGARTNER, ERICA THOMPSON (ATC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:THOMPSON
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:527 WEST THAMES STREET
Mailing Address - Street 2:UNIT 56
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:571-225-1411
Mailing Address - Fax:860-429-0898
Practice Address - Street 1:13B DOG LN
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-2206
Practice Address - Country:US
Practice Address - Phone:860-429-0899
Practice Address - Fax:860-429-0898
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer