Healthcare Provider Details

I. General information

NPI: 1255370508
Provider Name (Legal Business Name): ERIC D. BORTMAS MS, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E TOWN ST
COLUMBUS OH
43215-4774
US

IV. Provider business mailing address

251 PARKLAWN BLVD
COLUMBUS OH
43213-1322
US

V. Phone/Fax

Practice location:
  • Phone: 614-461-8174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-001495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: