Provider Demographics
NPI:1457553208
Name:EROVICK, DAVID D (PTA, ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:EROVICK
Suffix:
Gender:M
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2062
Mailing Address - Country:US
Mailing Address - Phone:360-901-5773
Mailing Address - Fax:
Practice Address - Street 1:201 NE PARK PLAZA DR.
Practice Address - Street 2:#246
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5874
Practice Address - Country:US
Practice Address - Phone:360-696-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07713225200000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer