Individual
BRADY CLINTON TOMLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, MS
Contact information
Practice address
2100 S MOBBERLY AVE, LONGVIEW, TX 75602-3564
(903) 233-3794
Mailing address
2100 S MOBBERLY AVE, LONGVIEW, TX 75602-3564
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
AT7014
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000024206
BOC CERTIFICATION NUMBER
—
01
—
AT7014
TEXAS LICENSED ATHLETIC TRAINER
TX
Enumeration date
07/16/2019
Last updated
07/16/2019
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