Provider Demographics
NPI:1326504622
Name:PARK, BRANDON JUYOUNG (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JUYOUNG
Last Name:PARK
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 W 38TH ST STE 132
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6404
Practice Address - Country:US
Practice Address - Phone:512-348-2515
Practice Address - Fax:512-961-8889
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60958690225100000X
GACP004992T225100000X
SC9526225100000X
TNCP003602T225100000X
TX1325979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist