Healthcare Provider Details

I. General information

NPI: 1124161179
Provider Name (Legal Business Name): PATRICK KYLE SAMPSELL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 EAST DR
MONTGOMERY AL
36117-7088
US

IV. Provider business mailing address

1930 GORGAS ST
MONTGOMERY AL
36106-1720
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-3234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number970
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: