Edward Ericksen

NPI #1043610199 in Bloomington, Illinois

Provider Information

NPI Number: 1043610199
Entity Type: Individual
Name: Edward Ericksen
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Enumeration Date: Aug 26, 2014
Last Updated: Feb 20, 2024

Practice Location

Address: 1111 TRINITY LN STE 111
City: Bloomington
State: Illinois
ZIP Code: 61704-8112
Phone: (309) 663-6461

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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