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General NPI Number Information
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NPI Number | 1730643792
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Entity Type | Individual
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Provider Name | BRIAN RICHARD MCELROY ATC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 515 LOUDON RD
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City | LOUDONVILLE
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State | NY
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Zip | 12211-1462
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Country | US
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Telephone | 518-783-2405
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Fax |
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Provider Business Mailing Address
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Address Line | 74 SALISBURY RD
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City | DELMAR
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State | NY
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Zip | 12054-1213
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Country | US
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Telephone | 518-312-1026
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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 | 002446
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License Number State | NY
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