Provider Demographics
NPI:1548690738
Name:PANNELL, ERIKA A (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:A
Last Name:PANNELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:A
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:1080 STELTON RD
Practice Address - Street 2:STE 203
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5200
Practice Address - Country:US
Practice Address - Phone:732-572-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01527000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist