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General NPI Number Information
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NPI Number | 1093253940
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Entity Type | Organization
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Legal Business Name | ERICKSON PT ENTERPRISES PLLC
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 1005 HIGHWAY 2
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City | SANDPOINT
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State | ID
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Zip | 83864-1702
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Country | US
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Telephone | 208-263-1632
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Fax | 208-255-2066
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Provider Business Mailing Address
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Address Line | 1005 HIGHWAY 2
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City | SANDPOINT
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State | ID
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Zip | 83864-1702
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Country | US
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Telephone | 208-263-1632
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Fax | 208-255-2066
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | SHAWNA E BENNER-ERICKSON
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Credential | MPT
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Telephone | 208-263-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1783
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License Number State | ID
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