Provider Demographics
NPI:1922111244
Name:HILDEBRANDT, BRIAN L (ATC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:HILDEBRANDT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2957 DAILEY DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-6286
Mailing Address - Country:US
Mailing Address - Phone:605-996-8268
Mailing Address - Fax:
Practice Address - Street 1:625 N FOSTER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2969
Practice Address - Country:US
Practice Address - Phone:605-996-3963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer