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General NPI Number Information
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NPI Number | 1154477255
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Entity Type | Individual
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Provider Name | BRIAN ELIAS IRWIN
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 725 SKIPPACK PIKE SUIUTE 300
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City | BLUE BELL
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State | PA
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Zip | 19422-1741
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Country | US
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Telephone | 866-894-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 122 BANYAN CIRCLE DR
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City | LANCASTER
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State | PA
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Zip | 17603-4494
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Country | US
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Telephone | 717-393-2250
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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 |
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License Number State |
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