Individual
JEFF CHARLES ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1228 COUNTRY CLUB RD, SUITE 400, FAIRMONT, WV 26554-2369
(304) 366-0461
(304) 366-0497
Mailing address
943 MAPLE DR, MORGANTOWN, WV 26505-2812
(304) 599-2515
(304) 285-3738
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001468
WV
225100000X
Physical Therapist
PT010007L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157417000
—
WV
Enumeration date
06/27/2006
Last updated
10/25/2013
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