Brandon Trent Owen, ATC, CSCS

Key facts

NPI

1346637501

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

0126001693 (VA)

Practice address

200 Military Dr
Chatham, VA 24531-4658

Phone

(434) 432-2481

Fax

(434) 432-3129

NPI assigned

Apr 24, 2015

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 24, 2015.

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429833600000",
    "number": "1346637501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11468 FRANKLIN TPKE",
            "city": "CHATHAM",
            "state": "VA",
            "postal_code": "245314923",
            "telephone_number": "434-251-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MILITARY DR",
            "city": "CHATHAM",
            "state": "VA",
            "postal_code": "245314658",
            "telephone_number": "434-432-2481",
            "fax_number": "434-432-3129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWEN",
        "first_name": "BRANDON",
        "middle_name": "TRENT",
        "credential": "ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-24",
        "last_updated": "2015-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126001693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Chatham, VA · Athletic Trainer in Virginia