Individual
MR. BRANDON SCOTT ELLENWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3504 HARRY LANGDON BLVD, COUNCIL BLUFFS, IA 51503-7829
(712) 366-8220
Mailing address
6752 N 164TH PLZ UNIT 3304 APT 4, OMAHA, NE 68116
(402) 649-6501
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
127245
IA
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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