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NPI Code Detail

MEDICARE: ERIC FREDRICKS ATC, LAT, PES

MEDICARE: ERIC FREDRICKS ATC, LAT, PES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAT 0000001801TN

General Provider Information

NPI Number : 1609266964
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC FREDRICKS ATC, LAT, PES
Provider Business Mailing Address
First Line : 3172 PECAN LAKE DR
Second Line : APARTMENT 205
City : MEMPHIS
State : TN
Zip : 38115-0480
Country : US
Telephone Number : 616-826-8409
Fax Number :
Provider Business Practice Location Address
First Line : 1115 E GETWELL LOOP
Second Line :
City : MEMPHIS
State : TN
Zip : 38152-4210
Country : US
Telephone Number : 901-678-3536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2015
Last Update Date : 01/26/2015

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Directions to “ ERIC FREDRICKS ATC, LAT, PES” Practice Location

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