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NPI Code Detail

MEDICARE: MR. BRIAN L FAIRBROTHER MS, ATC, CSCS

MEDICARE:  MR. BRIAN L FAIRBROTHER  MS, ATC, CSCS
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
12255A2300XAthletic Trainer000388CT

General Provider Information

NPI Number : 1235101775
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN L FAIRBROTHER MS, ATC, CSCS
Provider Business Mailing Address
First Line : 1 CIVIC CENTER PLZ
Second Line :
City : HARTFORD
State : CT
Zip : 06103-1504
Country : US
Telephone Number : 860-967-0478
Fax Number :
Provider Business Practice Location Address
First Line : 1 CIVIC CENTER PLZ
Second Line :
City : HARTFORD
State : CT
Zip : 06103-1504
Country : US
Telephone Number : 860-967-0478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 01/08/2015

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Directions to “ MR. BRIAN L FAIRBROTHER MS, ATC, CSCS” Practice Location

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