Provider Demographics
NPI:1164612362
Name:ROBERTS, BRIAN D (MA ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MA ATC, LAT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1401 BONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7267
Mailing Address - Country:US
Mailing Address - Phone:419-621-0035
Mailing Address - Fax:419-621-0039
Practice Address - Street 1:930 GLENMORE WAY APT G
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9429
Practice Address - Country:US
Practice Address - Phone:440-320-3406
Practice Address - Fax:419-621-0039
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAT 0018552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer