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General NPI Number Information
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NPI Number | 1588115216
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Entity Type | Individual
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Provider Name | MATTHEW GLENN BRANNON DPT, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 500 MARKAVIEW RD NW
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City | HUNTSVILLE
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State | AL
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Zip | 35805-3652
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Country | US
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Telephone | 256-533-8477
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Fax |
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Provider Business Mailing Address
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Address Line | 85 COUNTY ROAD 1251
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City | VINEMONT
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State | AL
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Zip | 35179-6337
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Country | US
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Telephone | 334-791-3137
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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 | 1986
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2-1312
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License Number State | AL
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