Healthcare Provider Details

I. General information

NPI: 1255534764
Provider Name (Legal Business Name): CHRISTOPHER C ERICKSON D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21015 CUMBERLAND DR STE 210
ELKHORN NE
68022-4110
US

IV. Provider business mailing address

5003 CROGANS WAY RD
COUNCIL BLUFFS IA
51501-8616
US

V. Phone/Fax

Practice location:
  • Phone: 402-932-5394
  • Fax:
Mailing address:
  • Phone: 402-320-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2828
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2828
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2828
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: