Provider Demographics
NPI:1396397576
Name:DAWSON, ERIK (MT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16291 W 14 MILE RD # RDSUITE5
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3327
Mailing Address - Country:US
Mailing Address - Phone:586-746-8967
Mailing Address - Fax:
Practice Address - Street 1:16291 W 14 MILE RD # RDSUITE5
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3327
Practice Address - Country:US
Practice Address - Phone:586-746-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist