Provider Demographics
NPI:1568963031
Name:ERICKSON, EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ERICKSON
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 1:4325 COVEY CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2502
Mailing Address - Country:US
Mailing Address - Phone:904-386-2224
Mailing Address - Fax:
Practice Address - Street 1:4325 COVEY CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2502
Practice Address - Country:US
Practice Address - Phone:904-386-2224
Practice Address - Fax:844-526-5446
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2020-03-04
Deactivation Date:2019-11-10
Deactivation Code:
Reactivation Date:2019-11-19
Provider Licenses
StateLicense IDTaxonomies
FLPT33064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty