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General NPI Number Information
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NPI Number | 1912505892
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Entity Type | Individual
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Provider Name | TYLER ERICKSON DPT
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Gender | Male
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 9430 NE VANCOUVER MALL DR
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City | VANCOUVER
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State | WA
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Zip | 98662-6172
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Country | US
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Telephone | 360-256-9827
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Fax |
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Provider Business Mailing Address
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Address Line | 32310 SE WREN RD
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City | ESTACADA
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State | OR
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Zip | 97023-9793
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Country | US
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Telephone | 503-593-5307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 63761
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License Number State | OR
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