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General NPI Number Information
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NPI Number | 1730387481
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Entity Type | Individual
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Provider Name | DOMENIC J ERRICO MPT
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Gender | Male
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Dates
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Enumeration Date | 07/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 N LOVEKIN BLVD UNIT 48
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City | BLYTHE
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State | CA
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Zip | 92225-1033
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Country | US
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Telephone | 760-989-8447
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N LOVEKIN BLVD UNIT 48
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City | BLYTHE
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State | CA
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Zip | 92225-1033
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Country | US
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Telephone | 760-989-8447
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 32492
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 3463
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License Number State | OR
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