Provider Demographics
NPI:1063500312
Name:BRANDON, ROBERT P (MPT ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4459
Mailing Address - Country:US
Mailing Address - Phone:707-294-2868
Mailing Address - Fax:
Practice Address - Street 1:3273 CLAREMONT WAY STE 101
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3328
Practice Address - Country:US
Practice Address - Phone:707-603-1030
Practice Address - Fax:707-251-1463
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT211971Medicare ID - Type Unspecified