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General NPI Number Information
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NPI Number | 1063801637
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Entity Type | Individual
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Provider Name | BRANDON HAWK L.A.T., A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 4351 RIDGEMONT DR
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City | ABILENE
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State | TX
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Zip | 79606-8746
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Country | US
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Telephone | 325-370-8499
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Fax |
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Provider Business Mailing Address
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Address Line | 826 FLAT WATER DR
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City | ABILENE
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State | TX
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Zip | 79602-7052
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Country | US
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Telephone | 325-370-8499
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Fax |
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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 | AT4806
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License Number State | TX
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