Provider Demographics
NPI:1588346530
Name:ERICKSON, MACY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CANNON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1334
Mailing Address - Country:US
Mailing Address - Phone:254-371-3179
Mailing Address - Fax:
Practice Address - Street 1:900 CANNON VALLEY DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1334
Practice Address - Country:US
Practice Address - Phone:254-371-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist