Provider Demographics
NPI:1245416981
Name:PETRAS, BRYAN MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:MICHAEL
Last Name:PETRAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 PRESIDENTIAL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7268
Mailing Address - Country:US
Mailing Address - Phone:614-791-0700
Mailing Address - Fax:
Practice Address - Street 1:3967 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7268
Practice Address - Country:US
Practice Address - Phone:614-791-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0118912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic