Provider Demographics
NPI:1952511834
Name:ERICKSMOEN, JANET D
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:D
Last Name:ERICKSMOEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 UPPER SAINT DENNIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2847
Mailing Address - Country:US
Mailing Address - Phone:651-699-5719
Mailing Address - Fax:
Practice Address - Street 1:1554 MIDWAY PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2415
Practice Address - Country:US
Practice Address - Phone:651-637-0362
Practice Address - Fax:651-637-0253
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist