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General NPI Number Information
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NPI Number | 1841769304
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Entity Type | Individual
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Provider Name | SCOTT BRYAN AT
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Gender | Male
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 5700 COOPER FOSTER PARK RD W
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City | LORAIN
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State | OH
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Zip | 44053-4152
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Country | US
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Telephone | 440-204-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 4079 STERLING STATION DR
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City | BRUNSWICK
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State | OH
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Zip | 44212-3992
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Country | US
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Telephone | 216-408-9412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002400
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License Number State | OH
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