Basic Information
| Provider Information | |||||||||
| NPI: | 1285059030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | ERICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11700 METRO AIRPORT CENTER DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ROMULUS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481741456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349557000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11700 METRO AIRPORT CENTER DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ROMULUS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481741456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349557000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2014 | ||||||||
| LastUpdateDate: | 03/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5502000417 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.