Basic Information
| Provider Information | |||||||||
| NPI: | 1053938878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORFI | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | LENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 632 BUCK CREEK RD | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377635218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248138388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2648 SEVIERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378043643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659841660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2020 | ||||||||
| LastUpdateDate: | 06/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TEI005137 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | PTA009896 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | PTA0000007422 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.