Provider Demographics
NPI:1003177569
Name:ERICKSON, TRENT (NCMT)
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17262 PARKSIDE DR S
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-0543
Mailing Address - Country:US
Mailing Address - Phone:303-746-4588
Mailing Address - Fax:
Practice Address - Street 1:455 W 115TH AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3095
Practice Address - Country:US
Practice Address - Phone:303-859-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-13285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist