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NPI Code Detail

MEDICARE: MR. ERIC SCOTT HOLSOPPLE ATC, LAT

MEDICARE: MR. ERIC SCOTT HOLSOPPLE ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist36001043AIN

General Provider Information

NPI Number : 1821061524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC SCOTT HOLSOPPLE ATC, LAT
Provider Business Mailing Address
First Line : 246 N 20TH AVE
Second Line :
City : BEECH GROVE
State : IN
Zip : 46107-1020
Country : US
Telephone Number : 317-727-2766
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3630
Country : US
Telephone Number : 317-788-3309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2006
Last Update Date : 07/08/2007

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