Provider Demographics
NPI:1083727739
Name:VANPATTEN, BRYN CHRISTOPHER (PHD, ATC, CSCS, EMT)
Entity Type:Individual
Prefix:DR
First Name:BRYN
Middle Name:CHRISTOPHER
Last Name:VANPATTEN
Suffix:
Gender:M
Credentials:PHD, ATC, CSCS, EMT
Other - Prefix:
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Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5301
Mailing Address - Country:US
Mailing Address - Phone:401-569-3867
Mailing Address - Fax:718-780-6539
Practice Address - Street 1:PROVIDENCE COLLEGE 1 CUNNINGHAM SQ
Practice Address - Street 2:CANAVAN SPORTS MEDICINE CENTER - ALUMNI HALL
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-0001
Practice Address - Country:US
Practice Address - Phone:401-865-2251
Practice Address - Fax:401-865-2965
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002442255A2300X
NY7092255A2300X
RIEMT14833146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate