Provider Demographics
NPI:1083484224
Name:OSTRANDER, BRANDON DALE (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DALE
Last Name:OSTRANDER
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 1:2105 BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2239
Mailing Address - Country:US
Mailing Address - Phone:910-515-8237
Mailing Address - Fax:
Practice Address - Street 1:2105 BARNETT AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2239
Practice Address - Country:US
Practice Address - Phone:910-515-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP20628208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation