Provider Demographics
NPI:1700990504
Name:BLACKFORD, ERIN FISHER (PT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:FISHER
Last Name:BLACKFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:FISHER
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5985 RICE CREEK PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5036
Mailing Address - Country:US
Mailing Address - Phone:763-229-4119
Mailing Address - Fax:
Practice Address - Street 1:5985 RICE CREEK PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5038
Practice Address - Country:US
Practice Address - Phone:651-484-6735
Practice Address - Fax:651-484-5663
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02775Medicare ID - Type Unspecified