Healthcare Provider Details

I. General information

NPI: 1922290428
Provider Name (Legal Business Name): BRYAN ANTHONY SIZEMORE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102B DUNHILL PLACE
CLEVELAND TN
37312
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-0444
  • Fax: 423-559-0103
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1037
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: