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General NPI Number Information
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NPI Number | 1740048099
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Entity Type | Individual
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Provider Name | CAMMIE DAWN BROST ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 777 AVENUE H BLDG C
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-7704
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 ROAD 9
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City | LOVELL
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State | WY
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Zip | 82431-9617
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 050
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License Number State | WY
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