Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1285271643 |
---|---|
Provider Name | Matthew Brancaleone |
First Address | Hilliard, OH 43026-8558 |
Second Address | Columbus, OH 43210-1442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 04/12/2019 |