Provider Demographics
NPI:1831310721
Name:BERKSTRESSER, BRANT DOUGLAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRANT
Middle Name:DOUGLAS
Last Name:BERKSTRESSER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HERTY DR
Mailing Address - Street 2:HANNER FIELDHOUSE, GEORGIA SOUTHERN UNIVERSITY
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30460-0001
Mailing Address - Country:US
Mailing Address - Phone:912-681-5053
Mailing Address - Fax:912-486-7690
Practice Address - Street 1:50 HERTY DR
Practice Address - Street 2:HANNER FIELDHOUSE, GEORGIA SOUTHERN UNIVERSITY
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30460-0001
Practice Address - Country:US
Practice Address - Phone:912-681-5053
Practice Address - Fax:912-486-7690
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer