Provider Demographics
NPI:1487175592
Name:FIES, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FIES
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 1:4113 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1967
Mailing Address - Country:US
Mailing Address - Phone:814-860-6544
Mailing Address - Fax:
Practice Address - Street 1:186 LAKE SHORE DR W
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-1437
Practice Address - Country:US
Practice Address - Phone:716-366-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009074225200000X
NY007993225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant