Provider Demographics
NPI:1760239776
Name:OBLACK, ERIN ALYCIA
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ALYCIA
Last Name:OBLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 THORPE LN APT 516
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7134
Mailing Address - Country:US
Mailing Address - Phone:512-395-7467
Mailing Address - Fax:
Practice Address - Street 1:1351 SADLER DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7775
Practice Address - Country:US
Practice Address - Phone:512-805-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2117420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant