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General NPI Number Information
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NPI Number | 1750789392
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Entity Type | Individual
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Provider Name | BRIAN CLEVEN ATC, LAT, RCEP
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Gender | Male
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Dates
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Enumeration Date | 12/14/2014
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Last Update Date | 12/14/2014
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Provider Practice Location Address
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Address Line | 3100 SHORE DR
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City | MARINETTE
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State | WI
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Zip | 54143-4242
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Country | US
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Telephone | 715-735-4200
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Fax |
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Provider Business Mailing Address
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Address Line | W2183 COUNTY ROAD B
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City | MARINETTE
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State | WI
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Zip | 54143-9462
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Country | US
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Telephone | 715-938-2306
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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 | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1009-39
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License Number State | WI
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