MEDICARE: BROOKE C AUGUST 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
1	2255A2300X	Athletic Trainer	A160047407	WA

General Provider Information

NPI Number	:	1568424695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE C AUGUST LAT, ATC

Provider Business Mailing Address
First Line	:	204 S COLLEGE AVE
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1198
Country	:	US
Telephone Number	:	509-527-2475
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 S COLLEGE AVE
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1198
Country	:	US
Telephone Number	:	509-527-2475
Fax Number	:

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	10/13/2022

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