Provider Demographics
NPI:1538500475
Name:BRANDT, JOHN C (RPH, AT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:BRANDT
Suffix:
Gender:M
Credentials:RPH, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 SOM CENTER RD
Mailing Address - Street 2:UNIVERSITY SCHOOL
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-6652
Mailing Address - Country:US
Mailing Address - Phone:216-831-2200
Mailing Address - Fax:216-292-7811
Practice Address - Street 1:2785 SOM CENTER RD
Practice Address - Street 2:UNIVERSITY SCHOOL
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-6652
Practice Address - Country:US
Practice Address - Phone:216-831-2200
Practice Address - Fax:216-292-7811
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0000182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer