Healthcare Provider Details

I. General information

NPI: 1508484742
Provider Name (Legal Business Name): TONI ERICSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STILES RD STE 203
SALEM NH
03079-4804
US

IV. Provider business mailing address

20 PRINCETON ST
MEDFORD MA
02155-5946
US

V. Phone/Fax

Practice location:
  • Phone: 855-390-7774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21227
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: