Provider Demographics
NPI:1417111451
Name:ERICKSON, CASSANDRA DONIELLE (PT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DONIELLE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:DONIELLE
Other - Last Name:MACZKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5042
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:2640 EAGAN WOODS DR STE 120
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1466
Practice Address - Country:US
Practice Address - Phone:651-968-5600
Practice Address - Fax:651-730-3998
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic