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General NPI Number Information
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NPI Number | 1093068975
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Entity Type | Individual
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Provider Name | ERIC PAUL VERDIN PTA
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Gender | Male
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1201 E MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49201-1852
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Country | US
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Telephone | 517-205-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 4644 RIVES EATON RD
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City | RIVES JUNCTION
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State | MI
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Zip | 49277-9651
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Country | US
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Telephone | 517-320-4993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502003560
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License Number State | MI
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