Provider Demographics
NPI:1699053520
Name:MICHITSCH, ERICA (DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MICHITSCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6345
Mailing Address - Country:US
Mailing Address - Phone:929-269-2505
Mailing Address - Fax:888-714-1889
Practice Address - Street 1:286 MADISON AVE STE 1601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6374
Practice Address - Country:US
Practice Address - Phone:646-678-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036888-1225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist