Healthcare Provider Details

I. General information

NPI: 1679616619
Provider Name (Legal Business Name): BRIAN A BRATTA ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ALUMNI ARENA THE STATE UNIVERSITY OF NEW YORK AT BUFFALO
BUFFALO NY
14260-5000
US

IV. Provider business mailing address

20 ALUMNI ARENA UNIVERSITY AT BUFFALO
BUFFALO NY
14260-5000
US

V. Phone/Fax

Practice location:
  • Phone: 716-645-3438
  • Fax: 716-645-3085
Mailing address:
  • Phone: 716-645-3438
  • Fax: 716-645-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003072-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: