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General NPI Number Information
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NPI Number | 1508801796
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Entity Type | Individual
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Provider Name | BRIAN D. HUMPHREY AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 800 MARTINSBURG ROAD PHYSICAL EDUCATION AND ATHLETICS MOUNT VERNON NAZARENE UNIVERSITY
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City | MOUNT VERNON
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State | OH
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Zip | 43050
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Country | US
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Telephone | 740-397-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 38 HILLTOP DR
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City | MOUNT VERNON
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State | OH
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Zip | 43050-1841
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT-1028
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License Number State | OH
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