Provider Demographics
NPI:1811152127
Name:DRESSANDER, ERIN PATRECE (MPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:PATRECE
Last Name:DRESSANDER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 BELL LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8354 100TH AVE
Practice Address - Street 2:STE 2
Practice Address - City:CANADIAN LAKES
Practice Address - State:MI
Practice Address - Zip Code:49346-8344
Practice Address - Country:US
Practice Address - Phone:231-972-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30046OtherBCBS
MI1811152127OtherNPI
MI30814OtherBCN
MI5501012396OtherMICHIGAN LICENSE NUMBER
MI236850Medicare Oscar/Certification