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Individual
MRS. SUE ERICSON AUSTIN
Active
Individual
MRS. SUE ERICSON AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
01748
IA
225100000X
Physical Therapist
Primary
P19920
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39259
WELLMARK PROVIDER NUMBER
IA
01
—
P19920
PT LICENSE
NC
Enumeration date
04/24/2007
Last updated
12/13/2023
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