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Contact Information

BRYAN BLACK, MAT, LAT, ATC, CKTP
3946 ICE WAY FORT WAYNE
FORT WAYNE, IN46808
 Phone: 517-425-4996
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for BRYAN BLACK · (Male)

NPI Number 1407358377
Status Active
Credentials MAT, LAT, ATC, CKTP
Entity Individual
Enumeration date 03/06/2018
Last updated 03/06/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 36002703A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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