| Doctor Name: | BRIAN BOADWINE |
| NPI Number: | 1205253622 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ATC |
| License Number: | 1684 |
| Business Practice Address: | 100 Bryan Chalk Ln Knightdale High School Knightdale, NC - 275456712 |
| Business Phone Number: | 9192175350 |
| Business Fax Number: | 9192175356 |
| Mailing Address: | 100 Bryan Chalk Ln, Knightdale High School KNIGHTDALE |
| State: | NC |
| Postal Code: | 275456712 |
| Phone Number: | 9192175350 |
| Fax Number: | 9192175356 |
| NPI Enumeration Date: | 03/24/2014 |
| NPI Last Update Date: | 03/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2255A2300X |
| License Number: | 1684 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Athletic Trainer |
| Taxonomy Definition: | Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor |