Basic Information
| Provider Information | |||||||||
| NPI: | 1104495829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNITZ | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | KIRK | ||||||||
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| Credential: | CTRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2071 OLD PHILADELPHIA PIKE APT 25 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176025758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176695150 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1400 BLACKHORSE HILL RD BLDG 138 | ||||||||
| Address2: | |||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193202040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103847711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225800000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist |
No ID Information.