Provider Demographics
NPI:1023393964
Name:BRANDNER, ERIN FAYE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:FAYE
Last Name:BRANDNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2521
Mailing Address - Country:US
Mailing Address - Phone:716-790-1479
Mailing Address - Fax:
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1513
Practice Address - Country:US
Practice Address - Phone:716-375-7481
Practice Address - Fax:716-375-6410
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007324-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant