Individual
ERICK A BUITRAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.ED., LAT, ATC
Contact information
Practice address
ATHLETIC TRAINING DEPARTMENT, ARENA RM B-17, TERRE HAUTE, IN 47809-0001
(812) 237-4066
(812) 237-9612
Mailing address
7979 SWEETWATER CT, APT. N, TERRE HAUTE, IN 47802-9503
(812) 237-4066
(812) 237-9612
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001258A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36001258A
ATHLETIC TRAINER LICENSE
IN
Enumeration date
08/09/2006
Last updated
07/08/2007
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