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General NPI Number Information
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NPI Number | 1023149762
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Entity Type | Individual
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Provider Name | BRETT A DAILEY MS ATC
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1120 HOUBOLT RD
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City | JOLIET
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State | IL
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Zip | 60431-9063
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Country | US
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Telephone | 815-741-2499
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Fax | 815-741-4222
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Provider Business Mailing Address
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Address Line | 1051 W US ROUTE 6 STE 400
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City | MORRIS
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State | IL
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Zip | 60450-3370
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Country | US
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Telephone | 815-942-8301
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Fax | 815-942-8449
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | IL
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