Provider Demographics
NPI:1497877005
Name:DRAKE, ERIC MICHAEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MICHAEL
Last Name:DRAKE
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 1:9734 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:MN
Mailing Address - Zip Code:55020-9630
Mailing Address - Country:US
Mailing Address - Phone:651-357-5117
Mailing Address - Fax:952-946-9888
Practice Address - Street 1:8100 W 78TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2516
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:952-946-9888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer