Basic Information
Provider Information
NPI: 1003004607
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRATIS
FirstName: ERIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1701 READING BLVD
Address2:  
City: WYOMISSING
State: PA
PostalCode: 196102605
CountryCode: US
TelephoneNumber: 6103601165
FaxNumber:  
Practice Location
Address1: 1701 READING BLVD
Address2:  
City: WYOMISSING
State: PA
PostalCode: 196102605
CountryCode: US
TelephoneNumber: 6103601165
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/09/2007
LastUpdateDate: 10/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251P0200XPT011791LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics

ID Information
IDTypeStateIssuerDescription
001782386000205PA MEDICAID


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