Bryan Gima-Derrow, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A160656701 Issued in WA

Practice address

3003 W Casino Rd
Mail Code: 0K-47
Everett, WA 98204-1910

Phone

(425) 903-6204

NPI assigned

Apr 18, 2016

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479513600000",
    "number": "1366896177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13916 N CREEK DR",
            "address_2": "3131",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980128416",
            "telephone_number": "707-628-5058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 W CASINO RD",
            "address_2": "MAIL CODE: 0K-47",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982041910",
            "telephone_number": "425-903-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIMA-DERROW",
        "first_name": "BRYAN",
        "name_prefix": "Mr.",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-18",
        "last_updated": "2016-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WA",
            "license": "A160656701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn E Gilligan, M.D.
• Nicolette Jeanne Gillingham
• Margo Gillis
• Michael Gilmore, RDH
• Nicholas Gilmore
• Amanda Beth Ginovsky, ARNP, FNP
• Alisha Emma Ginsberg, M.A.
• Joel L Gipson, M.S.
• Sherri Lynn Giragosian, PA-C
• Garrett Gird, M.ED.

• Athletic Trainer in Everett, WA
• Providers in Everett, WA by specialty
• Athletic Trainer in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2016; 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.