Provider Demographics
NPI:1548053069
Name:FASONE, BRAXTON (DPT)
Entity type:Individual
Prefix:
First Name:BRAXTON
Middle Name:
Last Name:FASONE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12541 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7656
Mailing Address - Country:US
Mailing Address - Phone:419-788-6530
Mailing Address - Fax:
Practice Address - Street 1:3101 W US HIGHWAY 224
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8305
Practice Address - Country:US
Practice Address - Phone:419-448-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0218012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic