MEDICARE: BRIAN NORTON A.T.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	A1 60047743	WA

General Provider Information

NPI Number	:	1003226382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN NORTON A.T.C.

Provider Business Mailing Address
First Line	:	207 PHYSICAL EDUCATION BUILDING
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-2476
Country	:	US
Telephone Number	:	509-359-6971
Fax Number	:	509-359-7388

Provider Business Practice Location Address
First Line	:	207 PHYSICAL EDUCATION BUILDING
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-2476
Country	:	US
Telephone Number	:	509-359-6971
Fax Number	:	509-359-7388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/07/2014

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