MEDICARE: ERIKA LYN ELY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P13986	NC

General Provider Information

NPI Number	:	1023596582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LYN ELY

Provider Business Mailing Address
First Line	:	1300 BRIDGE BARRIER RD STE 3
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3939
Country	:	US
Telephone Number	:	910-636-3574
Fax Number	:	910-636-3576

Provider Business Practice Location Address
First Line	:	1300 BRIDGE BARRIER RD STE 3
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3939
Country	:	US
Telephone Number	:	910-636-3574
Fax Number	:	910-636-3576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	12/16/2024

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