Provider Demographics
NPI:1568609022
Name:NELSON, ERIKA JEAN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:JEAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:JEAN
Other - Last Name:KOEPSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2523 S 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2621
Mailing Address - Country:US
Mailing Address - Phone:262-366-1610
Mailing Address - Fax:
Practice Address - Street 1:10101 S 27TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-7209
Practice Address - Country:US
Practice Address - Phone:414-325-4850
Practice Address - Fax:414-325-4851
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10477-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist