Healthcare Provider Details

I. General information

NPI: 1063964062
Provider Name (Legal Business Name): ERIN BERBERICH ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MIAMI VALLEY DR
CENTERVILLE OH
45459-4774
US

IV. Provider business mailing address

2793 DOUBLE EAGLE DR
BEAVERCREEK OH
45431-4711
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-2400
  • Fax:
Mailing address:
  • Phone: 937-546-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: