Provider Demographics
NPI:1073945218
Name:SITZ, BRANDON VANCE (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:VANCE
Last Name:SITZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 OUACHITA ST BOX 3652
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71998-0001
Mailing Address - Country:US
Mailing Address - Phone:870-245-5180
Mailing Address - Fax:870-245-5242
Practice Address - Street 1:410 OUACHITA ST BOX 3652
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71998-0001
Practice Address - Country:US
Practice Address - Phone:870-245-5180
Practice Address - Fax:870-245-5242
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT5762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer