MEDICARE: MS. ERIKA VOTRUBA DPT

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
2	225100000X	Physical Therapist	027506-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114907318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIKA VOTRUBA DPT

Provider Business Mailing Address
First Line	:	1133 MONTAUK HWY
Second Line	:
City	:	MASTIC
State	:	NY
Zip	:	11950-2918
Country	:	US
Telephone Number	:	631-399-0007
Fax Number	:	631-399-2992

Provider Business Practice Location Address
First Line	:	1636 MONTAUK HWY
Second Line	:
City	:	MASTIC
State	:	NY
Zip	:	11950-3016
Country	:	US
Telephone Number	:	631-399-0007
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	05/09/2019

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