Healthcare Provider Details

I. General information

NPI: 1528488434
Provider Name (Legal Business Name): CASSANDRA ERICKSON MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD
PHOENIX AZ
85013-4419
US

IV. Provider business mailing address

6424 E FAIRFIELD ST
MESA AZ
85205-6042
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4762
  • Fax: 602-406-4762
Mailing address:
  • Phone: 520-235-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number1318
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: