Provider Demographics
NPI:1093183758
Name:BIERSTEDT, ERIN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BIERSTEDT
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:BIERSTEDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:875 PERIMETER DR
Mailing Address - Street 2:UNIVERSITY OF IDAHO
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83844-2302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 PERIMETER DR
Practice Address - Street 2:UNIVERSITY OF IDAHO
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-2302
Practice Address - Country:US
Practice Address - Phone:208-885-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer