Provider Demographics
NPI:1821066945
Name:MASSIE, J BRETT (EDD, ATC)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:BRETT
Last Name:MASSIE
Suffix:
Gender:M
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 KENLEE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-1499
Mailing Address - Country:US
Mailing Address - Phone:513-405-7562
Mailing Address - Fax:
Practice Address - Street 1:1870 QUAKER WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2499
Practice Address - Country:US
Practice Address - Phone:937-481-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-1012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer