Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 13123-24 | WI |
N | 225200000X | Physical Therapy Assistant | 1190-019 | WI |
N | 225200000X | Physical Therapy Assistant | PTA-0684 | WY |
NPI | 1003112400 |
---|---|
Provider Name | Stephanie Erickson |
First Address | Sturtevant, WI 53177-0300 |
Second Address | Hayward, WI 54843-6717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2011 |
Last Update Date | 17/09/2015 |