MEDICARE: ERIKA LEA FAJMAN PT, 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	PT012548	GA

General Provider Information

NPI Number	:	1285189506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LEA FAJMAN PT, DPT

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-362-8684

Provider Business Practice Location Address
First Line	:	155 MEDICAL WAY
Second Line	:	STE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4940
Country	:	US
Telephone Number	:	770-991-2747
Fax Number	:	770-991-1704

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/16/2016

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