Provider Demographics
NPI:1568202927
Name:BRONSTRUP, JAROD
Entity type:Individual
Prefix:
First Name:JAROD
Middle Name:
Last Name:BRONSTRUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 HARWICH CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2110
Mailing Address - Country:US
Mailing Address - Phone:216-543-5152
Mailing Address - Fax:
Practice Address - Street 1:5052 WATERFORD DR UNIT 102
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1497
Practice Address - Country:US
Practice Address - Phone:440-934-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist