MEDICARE: ERIKA JADE TOWNSEND 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	LPT-31329	AZ

General Provider Information

NPI Number	:	1407436280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA JADE TOWNSEND PT, DPT

Provider Business Mailing Address
First Line	:	1930 N COUNTRY CLUB DR APT 2058
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-1789
Country	:	US
Telephone Number	:	626-643-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 N HIGLEY RD STE B-115
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-9602
Country	:	US
Telephone Number	:	480-699-8473
Fax Number	:	480-219-8237

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

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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