Healthcare Provider Details

I. General information

NPI: 1245937879
Provider Name (Legal Business Name): ERIN YASICK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S ADAMS ST
DENVER CO
80209-2908
US

IV. Provider business mailing address

797 W 29TH AVE UNIT 2218
DENVER CO
80202-1745
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-1146
  • Fax:
Mailing address:
  • Phone: 616-403-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018964
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: