Provider Demographics
NPI:1306345756
Name:ERRER, AMY (PTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ERRER
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 1:25990 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3450
Mailing Address - Country:US
Mailing Address - Phone:586-466-5234
Mailing Address - Fax:
Practice Address - Street 1:25990 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-3450
Practice Address - Country:US
Practice Address - Phone:586-466-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001783208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation