Provider Demographics
NPI:1841230059
Name:NIELSEN, ERIN (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0212
Mailing Address - Country:US
Mailing Address - Phone:585-582-1330
Mailing Address - Fax:585-582-2537
Practice Address - Street 1:20 ASSEMBLY DR STE 101
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-9609
Practice Address - Country:US
Practice Address - Phone:585-582-1330
Practice Address - Fax:585-582-2537
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018001225100000X
GACP040021T225100000X
NCCP043943T225100000X
VACP043917T225100000X
WAPT70022331225100000X
SC12567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFA0501OtherPREFERRED CARE
NYP0140059WHOtherBLUE CHOICE
NYFA0501OtherPREFERRED CARE