Provider Demographics
NPI:1801913983
Name:HERRON, ERICA (MPT)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 E CREEKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8368
Mailing Address - Country:US
Mailing Address - Phone:812-353-3343
Mailing Address - Fax:812-353-3346
Practice Address - Street 1:2605 E CREEKS EDGE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8368
Practice Address - Country:US
Practice Address - Phone:812-353-3343
Practice Address - Fax:812-353-3346
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013468225100000X
IN05010641A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7216OtherPERSONALCARE PROV ID
113326OtherHEALTHLINK PROV ID
IL203OtherBLUE CROSS PROV ID
IL4117OtherHAMP PROVIDER ID
IL4117OtherHAMP PROVIDER ID