Provider Demographics
NPI:1265821938
Name:APPLEGATE, ERICA (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:VOREL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, LAT
Mailing Address - Street 1:540 CAMBRIDGE CT
Mailing Address - Street 2:APT 2A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 CAMBRIDGE CT
Practice Address - Street 2:APT 2A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2456
Practice Address - Country:US
Practice Address - Phone:815-979-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002032A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer