Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Edward Ericksen

Individual provider Physical Therapist · NPI 1043610199

Edward Ericksen is a Physical Therapist in Private Practice in Bloomington, Illinois. Graduated from Des Moines University of Osteopathic Medicine and Health Sciences in 2011, 15 years ago. Practices with Carle West Physician Group Inc, a 285-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois, Ohio and Wisconsin.

Years since qualifying
15
Trained at
Des Moines University of Osteopathic Medicine and Health Sciences
Licensed in
IL, OH, WI
In the registry since
2014
Specialties on file
3
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Practice location Address checks out

1111 Trinity Ln Ste 111
Bloomington, IL 61704-8112
Phone: (309) 663-6461
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2901 W Kinnickinnic River Pkwy Ste 500, Milwaukee, WI 53215-3683 — (414) 649-3250

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 070027646 (IL)
Physical Therapist Taxonomy 225100000X · Licence PT.014702 (OH)
Physical Therapist Taxonomy 225100000X · Licence 13706 (WI)

Record details

NPI number1043610199
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 26, 2014
Last updated in NPPESFebruary 20, 2024
Certification dateFebruary 18, 2024
Mailing address611 W Park St, Fapc, Urbana, IL 61801-2500

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolDES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
Graduated 2011 (15 years in practice)
Group practice Carle West Physician Group Inc — 285 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Bloomington