Provider Demographics
NPI:1780778316
Name:ERVIN, ERICKA KATHLEEN (LPT)
Entity type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:KATHLEEN
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 830427
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-0427
Mailing Address - Country:US
Mailing Address - Phone:214-616-2932
Mailing Address - Fax:972-637-9270
Practice Address - Street 1:325 RIDGEHAVEN PL
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2537
Practice Address - Country:US
Practice Address - Phone:214-616-2932
Practice Address - Fax:972-637-9270
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11365052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6079OtherBLUECROSS BLUESHIELD
TX0632531-06Medicaid