Provider Demographics
NPI:1336761154
Name:NORTH, BRYSON (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:
Last Name:NORTH
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-9141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6289 US HIGHWAY 127
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OH
Practice Address - Zip Code:43556-9735
Practice Address - Country:US
Practice Address - Phone:419-658-2378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0046572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer