Provider Demographics
NPI:1326613290
Name:ERICKSON, RYAN DAVID (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 W 100 N
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1329
Mailing Address - Country:US
Mailing Address - Phone:435-767-0747
Mailing Address - Fax:435-767-0749
Practice Address - Street 1:2192 W 100 N
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-1329
Practice Address - Country:US
Practice Address - Phone:435-767-0747
Practice Address - Fax:435-767-0749
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4528225100000X
UT12060111-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4528OtherSTATE OF NEVADA PHYSICAL THERAPY BOARD
UT12060111-2401OtherSTATE OF UTAH DEPARTMENT OF COMMERCE DIVISION OF PROFESSIONAL LICENSING