MEDICARE: MR. TROY WAYNE BROWN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1689195968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TROY WAYNE BROWN LAT, ATC

Provider Business Mailing Address
First Line	:	7646A WASHINGTON AVE
Second Line	:
City	:	FAIRCHILD AIR FORCE BASE
State	:	WA
Zip	:	99011-3021
Country	:	US
Telephone Number	:	830-928-3156
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 E 29TH AVE STE 100
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-4868
Country	:	US
Telephone Number	:	509-724-4320
Fax Number	:

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

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	03/19/2021

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