Provider Demographics
NPI:1811205263
Name:BRANZEL, LISA A (AT,C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:BRANZEL
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 MARRISEY LOOP
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-7015
Mailing Address - Country:US
Mailing Address - Phone:740-913-0101
Mailing Address - Fax:
Practice Address - Street 1:7140 MARRISEY LOOP
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-7015
Practice Address - Country:US
Practice Address - Phone:740-913-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0012152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer