Provider Demographics
NPI:1720691256
Name:MARCIAL, ERICSON
Entity Type:Individual
Prefix:
First Name:ERICSON
Middle Name:
Last Name:MARCIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 BLUFFSTONE CV STE A201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7846
Mailing Address - Country:US
Mailing Address - Phone:800-967-2414
Mailing Address - Fax:
Practice Address - Street 1:2489 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6600
Practice Address - Country:US
Practice Address - Phone:951-268-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist