Healthcare Provider Details

I. General information

NPI: 1528602489
Provider Name (Legal Business Name): BRITTANY CARLSON DAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LAUREL ST STE B
DES MOINES IA
50314-3045
US

IV. Provider business mailing address

450 LAUREL ST STE B
DES MOINES IA
50314-3045
US

V. Phone/Fax

Practice location:
  • Phone: 515-323-6485
  • Fax:
Mailing address:
  • Phone: 515-323-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number109032
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: