Bryan Black, MAT, LAT, ATC, CKTP

Athletic Trainer · Fort Wayne, IN

Individual Active NPI

NPI number 1407358377

Practice location

3946 Ice Way Fort Wayne
Fort Wayne, IN 46808
Phone
(517) 425-4996

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NPI record

NPI
1407358377
Entity type
Individual (Type 1)
Enumeration date
March 6, 2018
Last updated
March 6, 2018
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Athletic Trainer Primary 2255A2300X 36002703A IN

About Bryan Black

Bryan Black, MAT, LAT, ATC, CKTP is a healthcare provider registered in the NPI registry with the primary taxonomy Athletic Trainer (code 2255A2300X). The practice location is 3946 Ice Way Fort Wayne, Fort Wayne, IN 46808. The NPI number 1407358377 was assigned on March 6, 2018 and the record was last updated on March 6, 2018.

Bryan Black lists a license in the registry: #36002703A (IN) for Athletic Trainer. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Bryan Black, MAT, LAT, ATC, CKTP?

The NPI number is 1407358377.

What is the phone number of Bryan Black?

The phone number listed for the practice location is (517) 425-4996.

Where is Bryan Black located?

3946 Ice Way Fort Wayne, Fort Wayne, IN 46808.

What is the taxonomy code for Bryan Black?

The primary taxonomy code is 2255A2300X – Athletic Trainer.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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