Provider Demographics
NPI:1376082115
Name:ERICKSON, KADE (DPT)
Entity Type:Individual
Prefix:
First Name:KADE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 W ANTELOPE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1139
Mailing Address - Country:US
Mailing Address - Phone:801-825-8091
Mailing Address - Fax:801-825-8142
Practice Address - Street 1:2055 N 1450 E
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2086
Practice Address - Country:US
Practice Address - Phone:435-363-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10177153-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist