Healthcare Provider Details

I. General information

NPI: 1023122884
Provider Name (Legal Business Name): WILLIAM SCOTT BREEZE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3194 BRIDLERUN DR
INDEPENDENCE KY
41051-6888
US

IV. Provider business mailing address

3194 BRIDLERUN DR
INDEPENDENCE KY
41051-6888
US

V. Phone/Fax

Practice location:
  • Phone: 859-356-4859
  • Fax:
Mailing address:
  • Phone: 859-356-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number3359P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT384
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: