Provider Demographics
NPI:1497240287
Name:EIRICH, MARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:EIRICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S HOLMEN DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9468
Mailing Address - Country:US
Mailing Address - Phone:608-526-9888
Mailing Address - Fax:608-526-9965
Practice Address - Street 1:3501 PARK LANE DR
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7747
Practice Address - Country:US
Practice Address - Phone:608-519-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist