Provider Demographics
NPI:1255784815
Name:BRANSKI, JARAD (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JARAD
Middle Name:
Last Name:BRANSKI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1651
Mailing Address - Country:US
Mailing Address - Phone:419-307-1338
Mailing Address - Fax:
Practice Address - Street 1:427 FLOYD ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1651
Practice Address - Country:US
Practice Address - Phone:419-639-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0043492255A2300X
FLAL 37712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer