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General NPI Number Information
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NPI Number | 1154505451
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Entity Type | Individual
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Provider Name | THOMAS BRADLEY MYRICK ATHLETIC TRAINER
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Gender | Male
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 800 MAIN ST
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City | GARDENDALE
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State | AL
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Zip | 35071-2634
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Country | US
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Telephone | 205-379-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 970 ROBIN DR
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City | MOUNT OLIVE
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State | AL
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Zip | 35117-3832
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Country | US
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Telephone | 205-608-3083
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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 | 527
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License Number State | AL
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