=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033512835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY ERICKSON DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2014
-----------------------------------------------------
Last Update Date | 10/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 PLAZA CT N
-----------------------------------------------------
City | SAINT CLAIR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63077-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-682-1266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3917A SHENANDOAH AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-4015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-682-1266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2014026929
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------