Provider Demographics
NPI:1093788036
Name:ERDMANN, JEREMY BRENT (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:BRENT
Last Name:ERDMANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1609 GLOVER RD
Mailing Address - Street 2:
Mailing Address - City:KIRKSEY
Mailing Address - State:KY
Mailing Address - Zip Code:42054-9033
Mailing Address - Country:US
Mailing Address - Phone:270-705-4448
Mailing Address - Fax:270-809-3815
Practice Address - Street 1:405A N. APPLIED SCIENCES BLDG.
Practice Address - Street 2:MURRAY STATE UNIVERSITY, DEPT. OF AHS
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-3306
Practice Address - Country:US
Practice Address - Phone:270-809-4517
Practice Address - Fax:270-809-3815
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT3872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer