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General NPI Number Information
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NPI Number | 1790115327
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Entity Type | Individual
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Provider Name | BRYAN S. SIMPSON MAT, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 2901 DRIVE OF CHAMPIONS STE. 200
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City | LUBBOCK
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State | TX
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Zip | 79409-6286
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Country | US
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Telephone | 806-445-1529
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 DRIVE OF CHAMPIONS STE. 200
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City | LUBBOCK
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State | TX
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Zip | 79409-6286
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Country | US
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Telephone | 806-445-1529
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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 | AT4737
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License Number State | TX
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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 | 2000003879
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License Number State | TX
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