Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bryan Black, MAT, LAT, ATC, CKTP

Individual provider Athletic Trainer · NPI 1407358377

Bryan Black, MAT, LAT, ATC, CKTP is an Athletic Trainer in Fort Wayne, Indiana. Licensed in Indiana. Registered with an NPI since 2018.

Licensed in
IN
In the registry since
2018
What do these letters mean?
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

3946 Ice Way Fort Wayne
Fort Wayne, IN 46808
Phone: (517) 425-4996
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 36002703A (IN)

Record details

NPI number1407358377
Entity typeIndividual (Type 1)
GenderMale
Credentials MAT , LAT , ATC , CKTP
Sole proprietorNo
NPI enumeratedMarch 6, 2018
Last updated in NPPESMarch 6, 2018

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