Individual
BRYAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAT, LAT, ATC, CKTP
Contact information
Practice address
3946 ICE WAY FORT WAYNE, FORT WAYNE, IN 46808
(517) 425-4996
Mailing address
3946 ICE WAY FORT WAYNE, FORT WAYNE, IN 46808
(517) 425-4996
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002703A
IN
Other
Enumeration date
03/06/2018
Last updated
03/06/2018
About Stedi
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