Basic Information
| Provider Information | |||||||||
| NPI: | 1053314138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERCY-FINE | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32490 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850642490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022304478 | ||||||||
| FaxNumber: | 6022309962 | ||||||||
| Practice Location | |||||||||
| Address1: | 8811 N 51ST AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853024949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239152726 | ||||||||
| FaxNumber: | 6239152728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5446 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 571879 | 05 | AZ | MEDICAID |