Provider Demographics
NPI:1235848045
Name:PANTALEO, ERICA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:PANTALEO
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 RYE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7632
Mailing Address - Country:US
Mailing Address - Phone:802-864-0015
Mailing Address - Fax:
Practice Address - Street 1:9321 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3387
Practice Address - Country:US
Practice Address - Phone:802-864-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134494225100000X
AZLPT-034122208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT040.0134494OtherLICENSE NUMBER
AZLPT-034122Medicaid