Bruce Willard, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36000670A Issued in IN

Practice address

201 Pennsylvania Parkway
Thomas a Brady Sports Medicine Center PC
Indianapolis, IN 46280

Phone

(317) 491-5464

NPI assigned

Mar 27, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395878400000",
    "number": "1053738047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10356 PARKSHORE DR",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460385511",
            "telephone_number": "317-491-5464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PENNSYLVANIA PARKWAY",
            "address_2": "THOMAS A BRADY SPORTS MEDICINE CENTER PC",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46280",
            "telephone_number": "317-491-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "BRUCE",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-27",
        "last_updated": "2014-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36000670A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Wilkinson, MD
• Allyson Will, DPM
• Hunter Will
• Joanna Will, PSYD, HSPP
• Valerie R Will, OTR
• Claire Alanna Willard, MD
• Anne M Willet, FNP
• Britany Nicole Willett, NP
• Heather Rae Willett, PA
• Kelly Nicole Willett

• Athletic Trainer in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.