Provider Demographics
NPI:1174096754
Name:WHARTON, ERICA MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MARIE
Last Name:WHARTON
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 1:23 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10537-1541
Mailing Address - Country:US
Mailing Address - Phone:914-438-1152
Mailing Address - Fax:
Practice Address - Street 1:517 S A ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3806
Practice Address - Country:US
Practice Address - Phone:155-967-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295576225100000X
NY0435111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10251993Medicaid