Individual
EDWARD ERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 TRINITY LN STE 111, BLOOMINGTON, IL 61704-8112
(309) 663-6461
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801-2500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070027646
IL
225100000X
Physical Therapist
13706
WI
225100000X
Physical Therapist
PT.014702
OH
Other
Enumeration date
08/26/2014
Last updated
02/20/2024
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