Individual
BRANNON TYSHAUN COUSIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 HILLCREST DR, RAPID CITY, SD 57701-3654
(605) 454-7910
Mailing address
28 HILLCREST DR, RAPID CITY, SD 57701-3654
(605) 454-7910
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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