Provider Demographics
NPI:1083084933
Name:ERICKSON, RYAN RICHARD (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RICHARD
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2113
Mailing Address - Country:US
Mailing Address - Phone:406-544-4192
Mailing Address - Fax:
Practice Address - Street 1:523 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2113
Practice Address - Country:US
Practice Address - Phone:406-544-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer