Healthcare Provider Details

I. General information

NPI: 1336272533
Provider Name (Legal Business Name): ERIK HERRMANN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 66TH ST N
ST PETERSBURG FL
33709-4949
US

IV. Provider business mailing address

3901 66TH ST N
ST PETERSBURG FL
33709-4949
US

V. Phone/Fax

Practice location:
  • Phone: 727-346-0822
  • Fax: 727-346-0823
Mailing address:
  • Phone: 727-346-0822
  • Fax: 727-346-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: