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General NPI Number Information
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NPI Number | 1073274536
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Entity Type | Individual
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Provider Name | BRINE SEIYA MURRAY LAT, ATC, OPE-C
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Gender | Male
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 812 GORMAN AVE
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City | ELKINS
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State | WV
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Zip | 26241-3181
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Country | US
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Telephone | 304-637-4509
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Fax |
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Provider Business Mailing Address
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Address Line | 59 COLLEGE AVE # MSC2070
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City | BUCKHANNON
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State | WV
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Zip | 26201-2600
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Country | US
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Telephone |
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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 | AT001819
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License Number State | WV
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