Provider Demographics
NPI:1780619080
Name:MERRILL, ERIN (PT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BAKER AVE
Mailing Address - Street 2:P.O. DRAWER 1200
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2337
Mailing Address - Country:US
Mailing Address - Phone:205-280-6450
Mailing Address - Fax:205-280-6451
Practice Address - Street 1:110 BAKER AVE
Practice Address - Street 2:P.O. DRAWER 1200
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2337
Practice Address - Country:US
Practice Address - Phone:205-280-6450
Practice Address - Fax:205-280-6451
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-06212OtherBLUE CROSS BLUE SHEILD
AL515-06212OtherBLUE CROSS BLUE SHEILD