Provider Demographics
NPI:1235600354
Name:GEORGE, BRANDON DAVID (PTA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 OAKINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4681
Mailing Address - Country:US
Mailing Address - Phone:407-738-3337
Mailing Address - Fax:
Practice Address - Street 1:5018 DR PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3310
Practice Address - Country:US
Practice Address - Phone:407-532-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA290002081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine