Provider Demographics
NPI:1992705511
Name:PARRISH, ERIC ALAN (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:PARRISH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N RICHMOND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1059
Mailing Address - Country:US
Mailing Address - Phone:610-944-8190
Mailing Address - Fax:
Practice Address - Street 1:805 N RICHMOND ST STE 103
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1059
Practice Address - Country:US
Practice Address - Phone:610-944-8190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA151514Medicaid
PA151514Medicaid