Provider Demographics
NPI:1205345543
Name:AVILA, ERICA ANGELA JOSON (PT)
Entity type:Individual
Prefix:
First Name:ERICA ANGELA
Middle Name:JOSON
Last Name:AVILA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 SHALER BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-3719
Mailing Address - Country:US
Mailing Address - Phone:201-682-1920
Mailing Address - Fax:
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:403B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-429-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037561-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist