Healthcare Provider Details

I. General information

NPI: 1861342925
Provider Name (Legal Business Name): GLYNISS BRYCE BOOKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6895 HIGHWAY 75
PINSON AL
35126-2999
US

IV. Provider business mailing address

706 SHOFFNER ST
EAST BREWTON AL
36426-2656
US

V. Phone/Fax

Practice location:
  • Phone: 251-363-9645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: