Provider Demographics
NPI:1174703938
Name:ERICKSEN, SARA M (PT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:M
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:111 SUNNYVIEW LANE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-077-9904
Mailing Address - Fax:
Practice Address - Street 1:111 SUNNYVIEW LANE, STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3161
Practice Address - Country:US
Practice Address - Phone:406-407-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist