Provider Demographics
NPI:1457546673
Name:ATWELL, BRIAN RICK SR (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RICK
Last Name:ATWELL
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2178 JOHNSON AVE # PHF
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4535
Mailing Address - Country:US
Mailing Address - Phone:805-781-4752
Mailing Address - Fax:805-781-4726
Practice Address - Street 1:2178 JOHNSON AVE # PHF
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-781-4752
Practice Address - Fax:805-781-4726
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28932167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician