Provider Demographics
NPI:1821061524
Name:HOLSOPPLE, ERIC SCOTT (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SCOTT
Last Name:HOLSOPPLE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1020
Mailing Address - Country:US
Mailing Address - Phone:317-727-2766
Mailing Address - Fax:
Practice Address - Street 1:1400 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3630
Practice Address - Country:US
Practice Address - Phone:317-788-3309
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001043A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist