Provider Demographics
NPI:1265075394
Name:ERDMAN, NICHOLAS KEVIN (PHD, LAT, ATC, CISSN)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:KEVIN
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:PHD, LAT, ATC, CISSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 BROWNTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-7643
Mailing Address - Country:US
Mailing Address - Phone:540-323-0080
Mailing Address - Fax:
Practice Address - Street 1:1460 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5195
Practice Address - Country:US
Practice Address - Phone:540-642-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260023462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer