Provider Demographics
NPI:1801092176
Name:WONDER, ERIN (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WONDER
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 1:1101 S CAPITAL OF TEXAS HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6445
Mailing Address - Country:US
Mailing Address - Phone:800-967-4667
Mailing Address - Fax:866-273-4090
Practice Address - Street 1:310 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3346
Practice Address - Country:US
Practice Address - Phone:940-235-1219
Practice Address - Fax:940-235-1220
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3104059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX3104059OtherTX TEMP LICENSE
TX3104059OtherHUMANA