Basic Information
| Provider Information | |||||||||
| NPI: | 1801092176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONDER | ||||||||
| FirstName: | ERIN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 S CAPITAL OF TEXAS HWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787466445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009674667 | ||||||||
| FaxNumber: | 8662734090 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 W SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | HENRIETTA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763653346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402351219 | ||||||||
| FaxNumber: | 9402351220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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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 | 225100000X | 3104059 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 111408402 | 05 | TX | MEDICAID | 3104059 | 01 | TX | TX TEMP LICENSE | OTHER | 3104059 | 01 | TX | HUMANA | OTHER |