Provider Demographics
NPI:1780113712
Name:ERICSON, DARCI (PT)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:ERICSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1576 PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-9131
Mailing Address - Country:US
Mailing Address - Phone:970-396-0686
Mailing Address - Fax:
Practice Address - Street 1:1576 PLAINS DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-9131
Practice Address - Country:US
Practice Address - Phone:970-396-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist