Individual
MR. BRIAN THOMAS RAYPOLE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LAT ATC
Contact information
Practice address
5050 N. CLINTON STREET, FORT WAYNE, IN 46809
(260) 484-8551
Mailing address
3609 BLUEGRASS LN, FORT WAYNE, IN 46815-6455
(260) 485-2985
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001169A
IN
Other
Enumeration date
03/20/2006
Last updated
07/08/2007
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