Healthcare Provider Details

I. General information

NPI: 1114666831
Provider Name (Legal Business Name): ERIN M ROOT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 OSIGIAN BLVD
WARNER ROBINS GA
31088-8958
US

IV. Provider business mailing address

405 OSIGIAN BLVD
WARNER ROBINS GA
31088-8958
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-3535
  • Fax: 478-953-0353
Mailing address:
  • Phone: 478-953-3535
  • Fax: 478-953-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: