MEDICARE: MR. JOHN C BRANDT RPH, AT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT000018	OH

General Provider Information

NPI Number	:	1538500475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN C BRANDT RPH, AT, ATC

Provider Business Mailing Address
First Line	:	2785 SOM CENTER RD
Second Line	:	UNIVERSITY SCHOOL
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-6652
Country	:	US
Telephone Number	:	216-831-2200
Fax Number	:	216-292-7811

Provider Business Practice Location Address
First Line	:	2785 SOM CENTER RD
Second Line	:	UNIVERSITY SCHOOL
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-6652
Country	:	US
Telephone Number	:	216-831-2200
Fax Number	:	216-292-7811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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