Individual
JONATHAN WADE ERHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
51385 SW OLD PORTLAND RD, SCAPPOOSE, OR 97056-4061
(503) 543-7768
(503) 543-7772
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3420
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029036
—
OR
01
—
DF4105
RAILROAD MEDICARE
OR
Enumeration date
05/17/2006
Last updated
01/24/2017
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