Provider Demographics
NPI:1316304819
Name:OSTREM, ERICA (PTA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:OSTREM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HAMILTON DRIVE
Mailing Address - Street 2:STE 100
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014
Mailing Address - Country:US
Mailing Address - Phone:515-357-5078
Mailing Address - Fax:
Practice Address - Street 1:2200 HAMILTON DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014
Practice Address - Country:US
Practice Address - Phone:515-357-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073969225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant