Provider Demographics
NPI:1235255415
Name:STORSVED, ERIC LEW (ATC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEW
Last Name:STORSVED
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BELL TOWER CT
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-7677
Mailing Address - Country:US
Mailing Address - Phone:336-278-6716
Mailing Address - Fax:
Practice Address - Street 1:2500 CAMPUS BOX
Practice Address - Street 2:ELON ATHLETICS
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-0001
Practice Address - Country:US
Practice Address - Phone:336-278-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer