Doctor Name: | DR. MARK R ERICKSON |
NPI Number: | 1225325111 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 2755-024 |
Business Practice Address: | 161 W Wisconsin Ave Pewaukee, WI - 530723467 |
Business Phone Number: | 2623498424 |
Business Fax Number: | |
Mailing Address: | 305 Woodlands Ct, HARTLAND |
State: | WI |
Postal Code: | 530292295 |
Phone Number: | 2623498424 |
Fax Number: | |
NPI Enumeration Date: | 06/30/2011 |
NPI Last Update Date: | 06/30/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251H1300X |
License Number: | 2755-024 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Human Factors |
Taxonomy Definition: |