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General NPI Number Information
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NPI Number | 1376899484
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Entity Type | Individual
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Provider Name | LESLIE BROOKS ATWOOD ATC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 3300 POINSETT HWY
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City | GREENVILLE
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State | SC
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Zip | 29613-0002
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Country | US
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Telephone | 864-294-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 CALEDON CT
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City | GREENVILLE
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State | SC
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Zip | 29615-3189
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Country | US
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Telephone | 843-496-4331
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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 | 1262
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License Number State | SC
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