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General NPI Number Information
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NPI Number | 1558003541
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Entity Type | Individual
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Provider Name | MR. BRIAN WILLIAM DENISON
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Gender | Male
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 403 DELOSS DODDS WAY
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City | AUSTIN
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State | TX
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Zip | 78712-1417
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Country | US
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Telephone | 254-784-3905
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Fax |
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Provider Business Mailing Address
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Address Line | 5422 95TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-4412
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Country | US
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Telephone | 254-784-3905
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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 | AT9516
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License Number State | TX
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