Erickson Gascon, PT
Individual provider Active NPI Physical Therapist · Tamuning, GU
NPI 1104333731 · NPPES record last updated Jan 4, 2018
Key facts
- NPI
- 1104333731
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 32 (GU)
- Practice address
- 548 S Marine Corps Dr
Tamuning, GU 96913-3539 - Phone
- (671) 646-5825
- NPI assigned
- Jan 4, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32 | GU | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 32 | GU | Yes |
Addresses
Primary practice location
548 S Marine Corps Dr
Tamuning, GU 96913-3539
Mailing address
PO Box 315571
Tamuning, GU 96931-3471
Phone (671) 787-0113
Other providers in Tamuning, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.