Healthcare Provider Details

I. General information

NPI: 1003725334
Provider Name (Legal Business Name): WESLEY EMRYS ERICKSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E TAHUYA DR
SHELTON WA
98584-9055
US

IV. Provider business mailing address

61 E TAHUYA DR
SHELTON WA
98584-9055
US

V. Phone/Fax

Practice location:
  • Phone: 425-780-7895
  • Fax:
Mailing address:
  • Phone: 425-780-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70167359
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: