Provider Demographics
NPI:1891207528
Name:BARONI, BRANDON J (AT, ATC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:BARONI
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 1:7904 DONEGAL CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-4802
Mailing Address - Country:US
Mailing Address - Phone:248-330-2234
Mailing Address - Fax:
Practice Address - Street 1:1025 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8739
Practice Address - Country:US
Practice Address - Phone:248-627-1829
Practice Address - Fax:248-627-6913
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010003402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer