Healthcare Provider Details

I. General information

NPI: 1801467360
Provider Name (Legal Business Name): BRYNLEY BOWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 N MAPLE AVE
FRESNO CA
93740-0001
US

IV. Provider business mailing address

6073 N FLORA AVE
FRESNO CA
93710-5609
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-4240
  • Fax:
Mailing address:
  • Phone: 559-974-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: