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NPI Code Detail

MEDICARE: MR. TIMOTHY J ERICKSON MPT

MEDICARE: MR. TIMOTHY J ERICKSON MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist9518-024WI

General Provider Information

NPI Number : 1952393399
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY J ERICKSON MPT
Provider Business Mailing Address
First Line : 446 OAKWOOD DR
Second Line :
City : OREGON
State : WI
Zip : 53575-3433
Country : US
Telephone Number : 608-280-7036
Fax Number :
Provider Business Practice Location Address
First Line : 2500 OVERLOOK TER
Second Line :
City : MADISON
State : WI
Zip : 53705-2254
Country : US
Telephone Number : 608-280-7036
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 11/08/2007

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