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General NPI Number Information
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NPI Number | 1124161179
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Entity Type | Individual
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Provider Name | PATRICK KYLE SAMPSELL ATC
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7400 EAST DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-7088
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Country | US
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Telephone | 334-244-3234
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 GORGAS ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1720
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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 | 970
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License Number State | AL
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