Provider Demographics
NPI:1265400444
Name:BRAMMER, MARK A JR (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BRAMMER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8591 CROSSROADS DRIVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514
Mailing Address - Country:US
Mailing Address - Phone:330-758-0577
Mailing Address - Fax:330-758-0466
Practice Address - Street 1:1397 S CANFIELD NILES RD
Practice Address - Street 2:UNIT 1
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4084
Practice Address - Country:US
Practice Address - Phone:330-953-0129
Practice Address - Fax:330-953-0650
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501010998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650C913860OtherBCBS
MI650C913860OtherBCBS
MIN64470008Medicare PIN