Organization
ERICKSON PT ENTERPRISES PLLC
Active
Other names
Lake Country Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA E BENNER-ERICKSON MPT (OWNER/PHYSICAL THERAPIST)
(208) 263-1632
Entity
Organization
Contact information
Practice address
1005 HIGHWAY 2, SANDPOINT, ID 83864-1702
(208) 263-1632
(208) 255-2066
Mailing address
1005 HIGHWAY 2, SANDPOINT, ID 83864-1702
(208) 263-1632
(208) 255-2066
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1783
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806604100
—
ID
Enumeration date
02/10/2017
Last updated
02/10/2017
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