Provider Demographics
NPI:1497976625
Name:JOST, ERICA ANNE (ATC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANNE
Last Name:JOST
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21939 464TH AVE
Mailing Address - Street 2:
Mailing Address - City:VOLGA
Mailing Address - State:SD
Mailing Address - Zip Code:57071
Mailing Address - Country:US
Mailing Address - Phone:605-695-7612
Mailing Address - Fax:
Practice Address - Street 1:1501 STATE STREET
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-537-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer