Provider Demographics
NPI:1831417401
Name:MERRITT, ERICKA (PT)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:M
Other - Last Name:FRYBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:42 WRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5847
Mailing Address - Country:US
Mailing Address - Phone:401-323-3178
Mailing Address - Fax:
Practice Address - Street 1:68 WILLOW RD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3653
Practice Address - Country:US
Practice Address - Phone:401-323-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008789225100000X
RIPT02354225100000X
CAPT293788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist