Provider Demographics
NPI:1063569812
Name:GINGRAS, ERIN A (PT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:A
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-361-3888
Mailing Address - Fax:207-361-3899
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-361-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH542065286OtherTAX IDENTIFICATION NUMBER
NH08Y002008NH01OtherANTHEM PROVIDER NUMBER
NH626470OtherHPHC PROVIDER NUMBER
NHP00473470Medicare PIN
NHRE7095Medicare PIN