Provider Demographics
NPI:1902016793
Name:KNUDSON, ERIC EDWARD (ATC-LAT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:EDWARD
Last Name:KNUDSON
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 1:4535 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2044
Mailing Address - Country:US
Mailing Address - Phone:563-332-9190
Mailing Address - Fax:563-332-8761
Practice Address - Street 1:3333 18TH ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2775
Practice Address - Country:US
Practice Address - Phone:563-332-4516
Practice Address - Fax:563-332-8761
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0002192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer