Healthcare Provider Details

I. General information

NPI: 1912606179
Provider Name (Legal Business Name): ERIN IHRIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 S MAIN ST APT 204
MOSCOW ID
83843-4253
US

IV. Provider business mailing address

1006 S MAIN ST APT 204
MOSCOW ID
83843-4253
US

V. Phone/Fax

Practice location:
  • Phone: 719-238-4105
  • Fax:
Mailing address:
  • Phone: 719-238-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number308210
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: