Healthcare Provider Details

I. General information

NPI: 1376967265
Provider Name (Legal Business Name): ERICA BELLAMY M. ED, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N JOHN R WOODEN DR
WEST LAFAYETTE IN
47907-2117
US

IV. Provider business mailing address

900 N JOHN R WOODEN DR
WEST LAFAYETTE IN
47907-2117
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-3245
  • Fax: 765-494-9899
Mailing address:
  • Phone: 765-494-3245
  • Fax: 765-494-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36004075A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: