Provider Demographics
NPI:1790115327
Name:SIMPSON, BRYAN S (MAT, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:S
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 DRIVE OF CHAMPIONS
Mailing Address - Street 2:STE. 200
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79409-6286
Mailing Address - Country:US
Mailing Address - Phone:806-445-1529
Mailing Address - Fax:
Practice Address - Street 1:2901 DRIVE OF CHAMPIONS
Practice Address - Street 2:STE. 200
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409-6286
Practice Address - Country:US
Practice Address - Phone:806-445-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT47372255A2300X
TX20000038792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer