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NPI Code Detail

MEDICARE: BRIAN EDWARD CONWAY ATC; LAT

MEDICARE: BRIAN EDWARD CONWAY 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
12255A2300XAthletic Trainer0803TX

General Provider Information

NPI Number : 1700878196
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN EDWARD CONWAY ATC; LAT
Provider Business Mailing Address
First Line : 2105 EDGEWOOD CT
Second Line :
City : ARLINGTON
State : TX
Zip : 76013-5408
Country : US
Telephone Number : 817-810-7504
Fax Number : 817-810-7501
Provider Business Practice Location Address
First Line : 800 5TH AVE
Second Line : SUITE 150
City : FORT WORTH
State : TX
Zip : 76104-7300
Country : US
Telephone Number : 817-810-7504
Fax Number : 817-810-7501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 07/08/2007

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Directions to “ BRIAN EDWARD CONWAY ATC; LAT” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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