Healthcare Provider Details

I. General information

NPI: 1124780762
Provider Name (Legal Business Name): BROOKE KLEINSCHMIDT LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 03/12/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 STADIUM TOWERS
TROY AL
36081-4508
US

IV. Provider business mailing address

1616 2ND AVE
TUSCALOOSA AL
35401-3504
US

V. Phone/Fax

Practice location:
  • Phone: 660-973-9333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2660
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: