Provider Demographics
NPI:1528421336
Name:ILKANICH, ERIKA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:ILKANICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 DILEY RD
Mailing Address - Street 2:STE 255
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9612
Mailing Address - Country:US
Mailing Address - Phone:614-834-2995
Mailing Address - Fax:614-834-3533
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:STE 255
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-834-2995
Practice Address - Fax:614-834-3533
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9591225100000X
OHPT016677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist