Provider Demographics
NPI:1639419336
Name:ERICKSON, DANA K (LMT)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:K
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:KAZMIRA
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2343 SE TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7976
Mailing Address - Country:US
Mailing Address - Phone:503-757-7975
Mailing Address - Fax:
Practice Address - Street 1:2343 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7976
Practice Address - Country:US
Practice Address - Phone:503-757-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15813172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist