Individual
MR. JEREMY RYAN BRAZIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
201 W. VAN ASCHE LOOP, FAYETTEVILLE, AR 72703-4974
(479) 966-4491
Mailing address
4809 W PLYMOUTH ROCK PL, FAYETTEVILLE, AR 72704-6907
(479) 966-4055
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT396
AR
Other
Enumeration date
10/25/2011
Last updated
06/06/2016
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