Provider Demographics
NPI:1770645467
Name:ERICKSON, TRENYA E (LMP)
Entity Type:Individual
Prefix:
First Name:TRENYA
Middle Name:E
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 W BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8936
Mailing Address - Country:US
Mailing Address - Phone:509-991-7692
Mailing Address - Fax:
Practice Address - Street 1:5544 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6434
Practice Address - Country:US
Practice Address - Phone:509-991-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA18806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist