Healthcare Provider Details

I. General information

NPI: 1669721908
Provider Name (Legal Business Name): ERIKA MICHELLE JENNINGS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA MICHELLE LANE PTA

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 VILLAGE RD
NEOSHO MO
64850-9076
US

IV. Provider business mailing address

8477 S SUNCOAST BLVD
HOMOSASSA FL
34446-5028
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-0822
  • Fax: 352-565-5201
Mailing address:
  • Phone: 800-381-0822
  • Fax: 352-565-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2012028524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: