Healthcare Provider Details

I. General information

NPI: 1316580152
Provider Name (Legal Business Name): BRIAN POWELL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 SAINT JOSEPH ST APT 228
NEW ORLEANS LA
70130-3649
US

IV. Provider business mailing address

344 SAINT JOSEPH ST APT 228
NEW ORLEANS LA
70130-3649
US

V. Phone/Fax

Practice location:
  • Phone: 508-596-4690
  • Fax:
Mailing address:
  • Phone: 508-596-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: