Provider Demographics
NPI:1164019550
Name:NGUYEN, BRANDON HAI SON (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:HAI SON
Last Name:NGUYEN
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 1:19847 CENTURY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7204
Mailing Address - Country:US
Mailing Address - Phone:240-912-2206
Mailing Address - Fax:240-912-2381
Practice Address - Street 1:19847 CENTURY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7204
Practice Address - Country:US
Practice Address - Phone:240-912-2206
Practice Address - Fax:240-912-2381
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist