Provider Demographics
NPI:1447671615
Name:EPPELHEIMER, BRADLY LOUIS (ATC)
Entity type:Individual
Prefix:
First Name:BRADLY
Middle Name:LOUIS
Last Name:EPPELHEIMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 17TH ST
Mailing Address - Street 2:ATHLETIC TRAINING ROOM
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1590
Mailing Address - Country:US
Mailing Address - Phone:847-977-3157
Mailing Address - Fax:
Practice Address - Street 1:4630 S LAKESHORE DR APT 182
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7174
Practice Address - Country:US
Practice Address - Phone:847-977-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002337A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer