Provider Demographics
NPI:1447512694
Name:ERICKSON, JUDITH N (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:N
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 LOS PADRES DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9281
Mailing Address - Country:US
Mailing Address - Phone:760-731-2515
Mailing Address - Fax:
Practice Address - Street 1:651 E PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3053
Practice Address - Country:US
Practice Address - Phone:760-291-0074
Practice Address - Fax:760-291-0076
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 10888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist