Provider Demographics
NPI:1730387481
Name:ERRICO, DOMENIC J (MPT)
Entity type:Individual
Prefix:MR
First Name:DOMENIC
Middle Name:J
Last Name:ERRICO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N LOVEKIN BLVD UNIT 48
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1033
Mailing Address - Country:US
Mailing Address - Phone:760-989-8447
Mailing Address - Fax:
Practice Address - Street 1:1000 N LOVEKIN BLVD UNIT 48
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1033
Practice Address - Country:US
Practice Address - Phone:760-989-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324922251G0304X
OR34632251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics