Provider Demographics
NPI:1578893988
Name:ERICKSON, SHARON DEBRA (DPT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DEBRA
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 1:391 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-7959
Mailing Address - Country:US
Mailing Address - Phone:563-568-2572
Mailing Address - Fax:
Practice Address - Street 1:391 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-7959
Practice Address - Country:US
Practice Address - Phone:563-568-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00481225100000X
TN8442225100000X
MN1650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist