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General NPI Number Information
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NPI Number | 1598331597
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Entity Type | Individual
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Provider Name | BRADY SPENCER BASSETT MSE, LAT
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Gender | Male
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 20303 BLUE SAGE PKWY
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City | OMAHA
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State | NE
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Zip | 68130-3721
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Country | US
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Telephone | 402-289-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 20303 BLUE SAGE PKWY
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City | OMAHA
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State | NE
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Zip | 68130-3721
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Country | US
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Telephone | 402-289-0616
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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 | 926
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License Number State | NE
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