Healthcare Provider Details

I. General information

NPI: 1609797810
Provider Name (Legal Business Name): BRYNN JOLMA LAT, ATC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 UNIVERSITY DR
BILLINGS MT
59101-0245
US

IV. Provider business mailing address

2702 8TH AVE N
BILLINGS MT
59101-1107
US

V. Phone/Fax

Practice location:
  • Phone: 406-657-2315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberPRD-LAT-LIC-1548
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: