Provider Demographics
NPI:1366955361
Name:WHAPHAM, ERIN (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WHAPHAM
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:POCONO LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18347-7859
Mailing Address - Country:US
Mailing Address - Phone:570-242-7365
Mailing Address - Fax:
Practice Address - Street 1:76 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-8025
Practice Address - Country:US
Practice Address - Phone:570-450-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0056602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer