Provider Demographics
NPI:1871500157
Name:FREISTAT, ERIN J (MPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:J
Last Name:FREISTAT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:J
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0179
Mailing Address - Country:US
Mailing Address - Phone:410-569-2626
Mailing Address - Fax:410-569-7370
Practice Address - Street 1:3450 EMMORTON RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2016
Practice Address - Country:US
Practice Address - Phone:410-569-2626
Practice Address - Fax:410-569-7370
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist