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General NPI Number Information
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NPI Number | 1093788036
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Entity Type | Individual
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Provider Name | JEREMY BRENT ERDMANN ATC
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 405A N. APPLIED SCIENCES BLDG. MURRAY STATE UNIVERSITY, DEPT. OF AHS
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City | MURRAY
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State | KY
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Zip | 42071-3306
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Country | US
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Telephone | 270-809-4517
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Fax | 270-809-3815
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Provider Business Mailing Address
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Address Line | 1609 GLOVER RD
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City | KIRKSEY
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State | KY
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Zip | 42054-9033
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Country | US
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Telephone | 270-705-4448
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Fax | 270-809-3815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT387
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License Number State | KY
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