Healthcare Provider Details

I. General information

NPI: 1528024361
Provider Name (Legal Business Name): SCOTT BRADLEY SWOPE ATC, LAT, EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 BISON TRL
GALLATIN TN
37066-8460
US

IV. Provider business mailing address

114 TEN OAKS DR E
HENDERSONVILLE TN
37075-4061
US

V. Phone/Fax

Practice location:
  • Phone: 615-451-6551
  • Fax:
Mailing address:
  • Phone: 615-822-7133
  • Fax: 615-230-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberEMT0000019804
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0000000102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: