Basic Information
Provider Information | |||||||||
NPI: | 1861907453 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SANCHEZ | ||||||||
FirstName: | ERIC | ||||||||
MiddleName: | DANIEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13946 BALTIMORE AVE | ||||||||
Address2: |   | ||||||||
City: | LAUREL | ||||||||
State: | MD | ||||||||
PostalCode: | 207075000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3014982212 | ||||||||
FaxNumber: | 3014982213 | ||||||||
Practice Location | |||||||||
Address1: | 1100 WILFORD HALL LOOP, BLDG 4554 | ||||||||
Address2: | ATTN: 59 MDW/SGHC | ||||||||
City: | JBSA LACKLAND | ||||||||
State: | TX | ||||||||
PostalCode: | 782369908 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9856409886 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/05/2017 | ||||||||
LastUpdateDate: | 10/01/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 225100000X | 26998 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.