Provider Demographics
NPI:1225247885
Name:MEYER, BRANDI SUE (LAT,PTA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUE
Last Name:MEYER
Suffix:
Gender:F
Credentials:LAT,PTA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:SUE
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT,PTA
Mailing Address - Street 1:11394 SAWMILL CURV
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-7759
Mailing Address - Country:US
Mailing Address - Phone:651-337-1445
Mailing Address - Fax:
Practice Address - Street 1:1560 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1191
Practice Address - Country:US
Practice Address - Phone:651-767-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI851-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant