Provider Demographics
NPI:1912350190
Name:TRAN, BRYAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:TRAN
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 1:61 N MOUNT PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2263
Mailing Address - Country:US
Mailing Address - Phone:847-912-5629
Mailing Address - Fax:
Practice Address - Street 1:60 W OLSEN RD
Practice Address - Street 2:LOS ANGELES RAMS/ATHLETIC TRAINING DEPT.
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2700
Practice Address - Country:US
Practice Address - Phone:847-912-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20000124932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer