Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2828 | NE |
N | 2251S0007X | Physical Therapist - Sports | 2828 | NE |
N | 2251X0800X | Physical Therapist - Orthopedic | 2828 | NE |
NPI | 1255534764 |
---|---|
Provider Name | Mr. Christopher C Erickson |
First Address | Council Bluffs, IA 51501-8616 |
Second Address | Elkhorn, NE 68022-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 26/09/2019 |