MEDICARE: BRIAN TORRES ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1917	MA

General Provider Information

NPI Number	:	1194112334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN TORRES ATC, LAT

Provider Business Mailing Address
First Line	:	332 PARK AVE
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02745-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 SPRING ST
Second Line	:
City	:	MARION
State	:	MA
Zip	:	02738-1518
Country	:	US
Telephone Number	:	508-748-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	04/24/2015

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