MEDICARE: MRS. TERESA ERICKSON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05004005A	IN

General Provider Information

NPI Number	:	1497808703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA ERICKSON P.T.

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	426 S ALABAMA ST STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-3301
Country	:	US
Telephone Number	:	317-528-6804
Fax Number	:	317-528-3781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/05/2023

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