Provider Demographics
NPI:1770548901
Name:DEERFOOT, ERIN JOY (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JOY
Last Name:DEERFOOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 260
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260
Mailing Address - Country:US
Mailing Address - Phone:360-321-4434
Mailing Address - Fax:360-321-4432
Practice Address - Street 1:432 3RD STREET
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-321-4434
Practice Address - Fax:360-321-4432
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5105ROOtherREGENCE
WA0314695OtherL&I PROVIDER ACCT NUMBER
WA8552415OtherCIGNA HELATHCARE
WA5105ROOtherREGENCE