Individual
BROOKE FADNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4 SHELTER DR, SOUND BEACH, NY 11789-2124
(631) 384-2871
Mailing address
4 SHELTER DR, SOUND BEACH, NY 11789-2124
(631) 384-2871
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001851-1
NY
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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