Provider Demographics
NPI:1023596582
Name:ELY, ERIKA LYN
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:LYN
Last Name:ELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-3939
Mailing Address - Country:US
Mailing Address - Phone:910-636-3574
Mailing Address - Fax:910-636-3576
Practice Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3939
Practice Address - Country:US
Practice Address - Phone:910-636-3574
Practice Address - Fax:910-636-3576
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist