Provider Demographics
NPI:1073628152
Name:WATERLAND, ERIK P (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:P
Last Name:WATERLAND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 N 30TH ST
Mailing Address - Street 2:#101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3356
Mailing Address - Country:US
Mailing Address - Phone:253-396-9001
Mailing Address - Fax:253-396-1231
Practice Address - Street 1:1807 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-3829
Practice Address - Country:US
Practice Address - Phone:253-396-9001
Practice Address - Fax:253-396-1231
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32174225100000X
WAPT00009854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT32174Medicare UPIN
CAOPT321740Medicare ID - Type Unspecified