Healthcare Provider Details

I. General information

NPI: 1043609282
Provider Name (Legal Business Name): ERIC CHRISTOPHER ROUX LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PERIMETER ROAD
CLEMSON SC
29633
US

IV. Provider business mailing address

21 PARK PLZ UNIT A
LIBERTY SC
29657-1323
US

V. Phone/Fax

Practice location:
  • Phone: 201-317-7555
  • Fax:
Mailing address:
  • Phone: 201-317-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: