Provider Demographics
NPI:1942309794
Name:MEYER, ERICA J (MSPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:MEYER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:J
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-315-9900
Mailing Address - Fax:303-315-9902
Practice Address - Street 1:2150 STADIUM DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0001
Practice Address - Country:US
Practice Address - Phone:303-415-4770
Practice Address - Fax:303-415-4769
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0011926225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60476222Medicaid