Healthcare Provider Details

I. General information

NPI: 1265821938
Provider Name (Legal Business Name): ERICA APPLEGATE MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA VOREL MS, ATC, LAT

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CAMBRIDGE CT APT 2A
MUNSTER IN
46321-2456
US

IV. Provider business mailing address

540 CAMBRIDGE CT APT 2A
MUNSTER IN
46321-2456
US

V. Phone/Fax

Practice location:
  • Phone: 815-979-7095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002032A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: