Provider Demographics
NPI:1073079059
Name:ERICKSON, TIFFANY NICOLE MORI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE MORI
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:19066 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2232
Mailing Address - Country:US
Mailing Address - Phone:714-968-0068
Mailing Address - Fax:
Practice Address - Street 1:19066 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2232
Practice Address - Country:US
Practice Address - Phone:714-968-0068
Practice Address - Fax:714-378-2290
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist