MEDICARE: ERICA FOUNDS PT

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	PT008037L	PA

General Provider Information

NPI Number	:	1518922434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA FOUNDS PT

Provider Business Mailing Address
First Line	:	12 W RIDGE RD
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-2562
Country	:	US
Telephone Number	:	610-565-6652
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 W LANCASTER AVE
Second Line	:	SUITE 125
City	:	WAYNE
State	:	PA
Zip	:	19087-2523
Country	:	US
Telephone Number	:	610-688-7776
Fax Number	:	610-688-4117

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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Directions to “ ERICA FOUNDS PT” Practice Location

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