Healthcare Provider Details

I. General information

NPI: 1962471771
Provider Name (Legal Business Name): ERIC SCOTT FLEDDERMAN ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

1113 COLUMBUS AVE
BATESVILLE IN
47006-7618
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-6624
  • Fax:
Mailing address:
  • Phone: 812-932-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000902A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: