Provider Demographics
NPI:1417959248
Name:DEPROOST, ERIK W (PT)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:W
Last Name:DEPROOST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 CROISAN CREEK RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9412
Mailing Address - Country:US
Mailing Address - Phone:505-819-7207
Mailing Address - Fax:
Practice Address - Street 1:528 COTTAGE ST NE STE 203
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3787
Practice Address - Country:US
Practice Address - Phone:505-819-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63984225100000X
NM2043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72727837Medicaid