Healthcare Provider Details

I. General information

NPI: 1124305214
Provider Name (Legal Business Name): THOMAS BRIAN BIRCHMEIER ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 E 10TH ST
BLOOMINGTON IN
47408-2619
US

IV. Provider business mailing address

3100 E FRANCES RD
CLIO MI
48420-9778
US

V. Phone/Fax

Practice location:
  • Phone: 812-856-4905
  • Fax:
Mailing address:
  • Phone: 810-938-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001714A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: