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NPI Code Detail

MEDICARE: MORGAN LYNNE BRANDT LAT, ATC

MEDICARE: MORGAN LYNNE BRANDT LAT, ATC
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 TrainerAT006904OH

General Provider Information

NPI Number : 1568130714
Entity Type Code : Individual
Provider Name (Legal Business Name) : MORGAN LYNNE BRANDT LAT, ATC
Provider Business Mailing Address
First Line : 57 TERRACE DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44512-2134
Country : US
Telephone Number : 330-550-4110
Fax Number :
Provider Business Practice Location Address
First Line : 1972 CLARK AVE
Second Line :
City : ALLIANCE
State : OH
Zip : 44601-3993
Country : US
Telephone Number : 330-550-4110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2021
Last Update Date : 11/15/2023

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