Provider Demographics
NPI:1588171516
Name:ERDIE, VIRGINIA A (ATR)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:ERDIE
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 HOLLYWOOD BLVD # 1010
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6635
Mailing Address - Country:US
Mailing Address - Phone:305-409-1662
Mailing Address - Fax:
Practice Address - Street 1:2035 DEWEY ST # 2
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6923
Practice Address - Country:US
Practice Address - Phone:305-409-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL95-090221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL95-090OtherATCB