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General NPI Number Information
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NPI Number | 1336279132
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Entity Type | Organization
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Legal Business Name | YOUNGSTOWN NEUROLOGIC ASSOCIATES
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1616 COVINGTON ST
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City | YOUNGSTOWN
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State | OH
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Zip | 44510-1244
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Country | US
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Telephone | 330-747-9215
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Fax | 330-747-9248
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Provider Business Mailing Address
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Address Line | 1616 COVINGTON ST
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City | YOUNGSTOWN
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State | OH
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Zip | 44510-1244
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Country | US
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Telephone | 330-747-9215
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Fax | 330-747-9248
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN P BROCKER
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Credential | M.D.
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Telephone | 330-747-9215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-09049
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License Number State | OH
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