Provider Demographics
NPI:1265679385
Name:ERICKSON REHAB AND ORTHOPEUTIC, LLC
Entity Type:Organization
Organization Name:ERICKSON REHAB AND ORTHOPEUTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANUARY
Authorized Official - Middle Name:RHEA
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-609-1378
Mailing Address - Street 1:1868 E FORBES CT
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-5602
Mailing Address - Country:US
Mailing Address - Phone:360-609-1378
Mailing Address - Fax:360-251-2000
Practice Address - Street 1:1868 E FORBES CT
Practice Address - Street 2:
Practice Address - City:LA CENTER
Practice Address - State:WA
Practice Address - Zip Code:98629-5602
Practice Address - Country:US
Practice Address - Phone:360-609-1378
Practice Address - Fax:360-251-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602442249332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies