Healthcare Provider Details

I. General information

NPI: 1275527830
Provider Name (Legal Business Name): GREG EHRMAN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TROJAN LN
BROOKVILLE IN
47012-8421
US

IV. Provider business mailing address

1245 LAMMERS PIKE
BATESVILLE IN
47006-9158
US

V. Phone/Fax

Practice location:
  • Phone: 812-576-3500
  • Fax:
Mailing address:
  • Phone: 812-934-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: