Provider Demographics
NPI:1245911023
Name:PATTERSON, BRIAN PAUL (ATC, PTA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 NORQUEST BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2201
Mailing Address - Country:US
Mailing Address - Phone:330-883-9949
Mailing Address - Fax:
Practice Address - Street 1:420 CAROLINE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1529
Practice Address - Country:US
Practice Address - Phone:330-480-3010
Practice Address - Fax:330-480-2594
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0017342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer