Provider Demographics
NPI:1679616619
Name:BRATTA, BRIAN A (ATC, CSCS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:BRATTA
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALUMNI ARENA
Mailing Address - Street 2:UNIVERSITY AT BUFFALO
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14260-5000
Mailing Address - Country:US
Mailing Address - Phone:716-645-3438
Mailing Address - Fax:716-645-3085
Practice Address - Street 1:20 ALUMNI ARENA
Practice Address - Street 2:THE STATE UNIVERSITY OF NEW YORK AT BUFFALO
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-5000
Practice Address - Country:US
Practice Address - Phone:716-645-3438
Practice Address - Fax:716-645-3085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003072-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer