Provider Demographics
NPI:1871143123
Name:ERICKSON, DANIEL WAYNE
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WAYNE
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N ROSENBERGER AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-6503
Mailing Address - Country:US
Mailing Address - Phone:812-491-3856
Mailing Address - Fax:812-303-0590
Practice Address - Street 1:700 HYUNDAI BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105-9622
Practice Address - Country:US
Practice Address - Phone:334-387-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist