Individual
MR. RANDALL SCOTT BRACKNEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC/LAT
Contact information
Practice address
220 N PATTERSON BLVD, DAYTON, OH 45402-1271
(937) 228-2287
Mailing address
302 LINCOLN ST, PLAINFIELD, IN 46168-1158
(317) 839-3423
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36000387A
IN
2255A2300X
Athletic Trainer
Primary
AT 002171
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36000387A
ATHLETIC TRAINERS LICENSE
IN
01
—
AT 002171
ATHLETIC TRAINERS LICENSE
OH
Enumeration date
04/14/2006
Last updated
07/08/2007
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