Eric William Bornholdt, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL4599 Issued in FL

Practice address

725 University Blvd
Beavercreek, OH 45324-2640

Phone

(937) 245-7550

Fax

(937) 425-0736

NPI assigned

Sep 14, 2017

Last updated

Sep 14, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505347200000",
    "number": "1932628617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2446 HEATHER GLEN DR #4",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "45431",
            "telephone_number": "507-272-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 UNIVERSITY BLVD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "453242640",
            "telephone_number": "937-245-7550",
            "fax_number": "937-425-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNHOLDT",
        "first_name": "ERIC",
        "middle_name": "WILLIAM",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-14",
        "last_updated": "2017-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL4599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Nicole Bonecutter, M.A., LPC
• Garrett Craig Boone, CRNA
• Stefanie Boone, RN
• Karen Joann Borchers, R.N. M.S.N. C.N.S.
• Theresa Marie Borchers, C.R.N.P.
• Bonnie Boshers
• Fatima Zehra Boumahchad
• Lisa Michelle Bowen, O.D.
• Marjorie A Bowman, MD
• Tessa Brand Boyce, FNP

• Athletic Trainer in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Athletic Trainer in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.