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General NPI Number Information
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NPI Number | 1265679385
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Entity Type | Organization
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Legal Business Name | ERICKSON REHAB AND ORTHOPEUTIC, LLC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 1868 E FORBES CT
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City | LA CENTER
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State | WA
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Zip | 98629-5602
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Country | US
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Telephone | 360-609-1378
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Fax | 360-251-2000
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Provider Business Mailing Address
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Address Line | 1868 E FORBES CT
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City | LA CENTER
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State | WA
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Zip | 98629-5602
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Country | US
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Telephone | 360-609-1378
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Fax | 360-251-2000
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANUARY RHEA ERICKSON
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Credential |
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Telephone | 360-609-1378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 602442249
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License Number State | WA
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