Provider Demographics
NPI:1033512835
Name:ERICKSON, ASHLEY (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917A SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-4015
Mailing Address - Country:US
Mailing Address - Phone:847-682-1266
Mailing Address - Fax:
Practice Address - Street 1:1035 PLAZA CT N
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-1132
Practice Address - Country:US
Practice Address - Phone:847-682-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014026929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist