Provider Demographics
NPI:1619119716
Name:ERICKSON, MARTHA (MT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 W 26TH AVE
Mailing Address - Street 2:SUITE A-200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:303-433-2300
Mailing Address - Fax:303-433-4222
Practice Address - Street 1:2490 W 26TH AVE
Practice Address - Street 2:SUITE A-200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5314
Practice Address - Country:US
Practice Address - Phone:303-433-2300
Practice Address - Fax:303-433-4222
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0005059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist