Provider Demographics
NPI:1255495180
Name:ERSSON, ERIC EDWARD (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:EDWARD
Last Name:ERSSON
Suffix:
Gender:M
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:411 HUKU LII PL STE 101
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-298-4933
Mailing Address - Fax:732-223-6409
Practice Address - Street 1:IMUA PHYSICAL THERAPY
Practice Address - Street 2:40 KUPAOA STREET B-201
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96753
Practice Address - Country:US
Practice Address - Phone:808-298-4933
Practice Address - Fax:808-298-4933
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJQA04764225100000X
HI5683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037102Medicare ID - Type Unspecified