Healthcare Provider Details

I. General information

NPI: 1578229886
Provider Name (Legal Business Name): ERICA MARIE ATTERBERRY PTA, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 DIAMOND RDG STE 800
JEFFERSON CITY MO
65109-7906
US

IV. Provider business mailing address

2518 HIDDEN VALLEY DR
HOLTS SUMMIT MO
65043-2524
US

V. Phone/Fax

Practice location:
  • Phone: 573-761-9360
  • Fax:
Mailing address:
  • Phone: 314-974-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2016037444
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2013005680
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: