Provider Demographics
NPI:1043632888
Name:KING, BRANDON (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 BIG BEAR MTN
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-9385
Mailing Address - Country:US
Mailing Address - Phone:828-227-2044
Mailing Address - Fax:828-227-7509
Practice Address - Street 1:92 CATAMOUNT RD
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723
Practice Address - Country:US
Practice Address - Phone:828-227-2044
Practice Address - Fax:828-227-7509
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer