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NPI Code Detail

MEDICARE: BRENDON EHRLICH PT, DPT, LAT, ATC

MEDICARE: BRENDON EHRLICH PT, DPT, LAT, ATC
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 Trainer755-17ND
2225100000XPhysical Therapist2311ND

General Provider Information

NPI Number : 1831649581
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDON EHRLICH PT, DPT, LAT, ATC
Provider Business Mailing Address
First Line : 217 W BURLEIGH AVE APT 214
Second Line :
City : BISMARCK
State : ND
Zip : 58504-9049
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1800 E INTERSTATE AVE
Second Line :
City : BISMARCK
State : ND
Zip : 58503-1399
Country : US
Telephone Number : 17-323-8943
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2016
Last Update Date : 07/28/2020

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