Provider Demographics
NPI:1083006829
Name:BARNARD, BRANDON ALLEN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ALLEN
Last Name:BARNARD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-4601
Mailing Address - Country:US
Mailing Address - Phone:256-348-0618
Mailing Address - Fax:
Practice Address - Street 1:4900 MERIDIAN ST NW
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762-7500
Practice Address - Country:US
Practice Address - Phone:256-372-8004
Practice Address - Fax:256-372-8480
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
AL19342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000022808OtherNATA BOC CERTIFIED ATHLETIC TRAINER