Provider Demographics
NPI:1437931797
Name:HALICK, ERICA GRACE (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:GRACE
Last Name:HALICK
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 MILE HIGH STADIUM CIR APT 818
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2766
Mailing Address - Country:US
Mailing Address - Phone:517-898-1765
Mailing Address - Fax:
Practice Address - Street 1:806 S PUBLIC RD STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2198
Practice Address - Country:US
Practice Address - Phone:720-406-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist