Provider Demographics
NPI:1205204575
Name:KING, ERIKA (MED, ATC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 W 29TH STREET #2108
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:951-805-4038
Mailing Address - Fax:
Practice Address - Street 1:BUTLER-HANCOCK ATHLETIC CENTER
Practice Address - Street 2:CAMPUS BOX 117
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639
Practice Address - Country:US
Practice Address - Phone:970-351-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT9092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer