Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 2000002879 | PA |
NPI | 1093387698 |
---|---|
Provider Name | Erica Reddick |
First Address | Aliquippa, PA 15001-3719 |
Second Address | Aliquippa, PA 15001-3719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2021 |
Last Update Date | 13/07/2021 |