Provider Demographics
NPI:1669838728
Name:CAGLE, BRYANT PATE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:PATE
Last Name:CAGLE
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8076 TYLERS CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2087
Mailing Address - Country:US
Mailing Address - Phone:513-795-2659
Mailing Address - Fax:
Practice Address - Street 1:8076 TYLERS CIR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2087
Practice Address - Country:US
Practice Address - Phone:513-795-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer