BRYAN BLACK (NPI# 1407358377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407358377 |
| Entity Type | Individual |
| Full Name | BRYAN BLACK |
| Credential | MAT, LAT, ATC, CKTP |
| Practice Address |
3946 Ice Way Fort Wayne Fort Wayne IN 46808 |
| Practice Telephone | 5174254996 |
| Mailing Telephone | 5174254996 |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2018-03-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
36002703A | IN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952846503 | Bryan Black | Hearing Instrument Specialist | 101 E Alex Bell Rd Ste 166, Centerville, OH 45459-2752 | 2017-01-05 |
| 1790787380 | Bryan L Black | Anesthesiology | 8080 E Central Ave, Ste 250, Wichita, KS 67206-2361 | 2005-08-12 |
| Street Address |
3946 ICE WAY FORT WAYNE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347102 | Austin Hartzog | Pharmacist | 5110 Value Drive, Fort Wayne, IN 46808 | 2020-08-21 |
| 1326557877 | Kimberly K Kolb | Occupational Therapy Assistant | 1431 Runnion Ave, Fort Wayne, IN 46808 | 2017-09-28 |
| 1396142063 | Christina Ryder | Specialist/Technologist | 3946 Iceway, Fort Wayne, IN 46808 | 2014-11-25 |
| 1912090440 | Neighborcare of Indiana, LLC | Pharmacy | 3402 Congressional Pkwy, Ft. Wayne, IN 46808 | 2006-10-02 |
| 1619945888 | Beth Ann Herrell | Specialist/Technologist | 3946 Ice Way, Fort Wayne, IN 46808 | 2006-03-14 |
| 1568458990 | Carolyn Warner Greer | Obstetrics & Gynecology | 1415 Directors Row, Fort Wayne, IN 46808 | 2005-09-21 |
| 1750851168 | Tyler Cheney | Specialist/Technologist | 3946 Ice Way, Fort Wayne, IN 46808 | 2018-11-28 |
| 1487123550 | Michaela Mcguire | Specialist/Technologist | 3946 Ice Way, Fort Wayne, IN 46808 | 2018-11-19 |
| 1861961088 | Olivia Marquardt | Specialist/Technologist | 3946 Ice Way, Fort Wayne, IN 46808 | 2018-11-16 |
| 1548762495 | Benjamin Chaz Charles | Specialist/Technologist | 3946 Ice Way, Fort Wayne, IN 46808 | 2018-03-07 |
| Find all providers in zip 46808 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699308700 | Jennifer N Peppler | Specialist/Technologist | 3434 Kirkfield Dr, Fort Wayne, IN 46815-5972 | 2020-02-17 |
| 1710519392 | Mitchell Mckay Enyart | Specialist/Technologist | 1617 Randford Pl, Fort Wayne, IN 46815-7635 | 2020-02-11 |
| 1003448671 | Chelsea L Harrison | Specialist/Technologist | 6716 Ramblewood Ct Apt L, Fort Wayne, IN 46835-1760 | 2020-02-11 |
| 1457983223 | Kayla Grotrian | Specialist/Technologist | 5440 Evard Rd, Fort Wayne, IN 46835-1796 | 2020-02-10 |
| 1730711680 | Danielle Rebecca Patton | Specialist/Technologist | 13303 Hawks View Blvd, Fort Wayne, IN 46845-8726 | 2020-02-09 |
| 1780220046 | Kelly Grayson | Specialist/Technologist | 1300 E Washington Center Rd, Fort Wayne, IN 46825-4556 | 2019-11-21 |
| 1265093280 | Emily Maria Giorgi | Specialist/Technologist | 2101 E Coliseum Blvd Ste 100, Fort Wayne, IN 46805-1499 | 2019-06-21 |
| 1194209791 | Autumn Brooke Meece | Specialist/Technologist | 5801 Meadows Dr Apt E, Fort Wayne, IN 46804-7639 | 2018-09-19 |
| 1275049686 | Julianna Davis | Specialist/Technologist | 615 Vance Ave, Fort Wayne, IN 46805-2143 | 2017-12-20 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46808 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.