Provider Demographics
NPI:1063295665
Name:CALEDONIA, ERIN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:CALEDONIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-6245
Mailing Address - Country:US
Mailing Address - Phone:339-832-2312
Mailing Address - Fax:
Practice Address - Street 1:31 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6245
Practice Address - Country:US
Practice Address - Phone:339-832-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9520225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant