MEDICARE: MR. BRIAN ANTHONY SIGMAN ATC,LAT

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	AT0001130362	WV

General Provider Information

NPI Number	:	1891573572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN ANTHONY SIGMAN ATC,LAT

Provider Business Mailing Address
First Line	:	175 MERCY WAY
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-1462
Country	:	US
Telephone Number	:	304-539-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-8605
Country	:	US
Telephone Number	:	304-539-0624
Fax Number	:

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

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/15/2023

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