Healthcare Provider Details

I. General information

NPI: 1376478586
Provider Name (Legal Business Name): MS. SOPHIA LOUISE ERIKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W MONROE ST
WYOCENA WI
53969-7168
US

IV. Provider business mailing address

W11927 WALL STREET RD
PORTAGE WI
53901-9614
US

V. Phone/Fax

Practice location:
  • Phone: 608-429-2181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4363-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: