Provider Demographics
NPI:1720498991
Name:O'FLANNIGAN, BRIAN (MSED, ATC, LAT, CES,)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:O'FLANNIGAN
Suffix:
Gender:M
Credentials:MSED, ATC, LAT, CES,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W GRANITE ST
Mailing Address - Street 2:#305
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9228
Mailing Address - Country:US
Mailing Address - Phone:307-460-0326
Mailing Address - Fax:406-723-2544
Practice Address - Street 1:400 S CLARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2328
Practice Address - Country:US
Practice Address - Phone:406-723-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer