Provider Demographics
NPI:1023229911
Name:ERICKSON, NIKKI (PT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:WINEGRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10235 S 51ST ST STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5221
Mailing Address - Country:US
Mailing Address - Phone:480-889-3206
Mailing Address - Fax:480-889-3205
Practice Address - Street 1:10235 S 51ST ST STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5221
Practice Address - Country:US
Practice Address - Phone:480-889-3206
Practice Address - Fax:480-889-3205
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist