Provider Demographics
NPI:1205212743
Name:WHITTINGTON, BRANDON THOMAS (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:THOMAS
Last Name:WHITTINGTON
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 1:10000 BEACH DR SW UNIT 9
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2856
Mailing Address - Country:US
Mailing Address - Phone:910-579-2745
Mailing Address - Fax:434-447-3282
Practice Address - Street 1:10000 BEACH DR SW UNIT 9
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2856
Practice Address - Country:US
Practice Address - Phone:910-579-2745
Practice Address - Fax:910-579-2847
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist