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General NPI Number Information
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NPI Number | 1881083780
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Entity Type | Individual
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Provider Name | BRYCE B GAINES LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 10753 FALLS RD SUITE 215
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4535
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Country | US
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Telephone | 410-847-3736
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Fax | 410-583-2855
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Provider Business Mailing Address
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Address Line | 10753 FALLS RD SUITE 215
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4535
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Country | US
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Telephone | 410-847-3736
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Fax | 410-583-2855
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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 | A0000371
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License Number State | MD
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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 | RT004939
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | J30000362
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License Number State | DE
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