Basic Information
| Provider Information | |||||||||
| NPI: | 1104850247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERICSSON | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 612260 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951612260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773252776 | ||||||||
| FaxNumber: | 4089454018 | ||||||||
| Practice Location | |||||||||
| Address1: | 246 SOBRANTE WAY | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940864807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087333670 | ||||||||
| FaxNumber: | 4082457968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 29409 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.