Healthcare Provider Details

I. General information

NPI: 1558933853
Provider Name (Legal Business Name): ERIK NICOLAS GEDIGIAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 W BOYNTON BEACH BLVD STE A11
BOYNTON BEACH FL
33437-6157
US

IV. Provider business mailing address

1020 AUDACE AVE APT 307
BOYNTON BEACH FL
33426-3394
US

V. Phone/Fax

Practice location:
  • Phone: 561-731-0163
  • Fax:
Mailing address:
  • Phone: 561-573-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: