Provider Demographics
NPI:1316999170
Name:STUMP, ERIN ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:STUMP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:141 TRIUNFO CYN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2525
Mailing Address - Country:US
Mailing Address - Phone:805-373-6560
Mailing Address - Fax:805-373-5120
Practice Address - Street 1:141 TRIUNFO CYN RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2525
Practice Address - Country:US
Practice Address - Phone:805-373-6560
Practice Address - Fax:805-373-5120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27147225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
P88115Medicare UPIN
WPT27147BMedicare ID - Type Unspecified