Individual
BRANT ALLEN BROUILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
58396 HEMMINGER DR, GOSHEN, IN 46528-9130
(574) 536-2070
Mailing address
58396 HEMMINGER DR, GOSHEN, IN 46528-9130
(574) 536-2070
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/20/2023
Last updated
01/20/2023
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