Provider Demographics
NPI:1871522284
Name:ERENRICH, CARISSA A (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:A
Last Name:ERENRICH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MISS
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:REVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTH CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-3610
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:54A LEBANON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-439-6294
Practice Address - Fax:724-439-8947
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015935850014Medicaid
PA154213ZDQKMedicare UPIN
PA0015935850014Medicaid