Individual
BRIAN BOADWINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
100 BRYAN CHALK LN, KNIGHTDALE HIGH SCHOOL, KNIGHTDALE, NC 27545-6712
(919) 217-5350
(919) 217-5356
Mailing address
100 BRYAN CHALK LN, KNIGHTDALE HIGH SCHOOL, KNIGHTDALE, NC 27545-6712
(919) 217-5350
(919) 217-5356
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1684
NC
Other
Enumeration date
03/24/2014
Last updated
03/24/2014
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