Provider Demographics
NPI:1326533001
Name:HAGEROTT, BRANDON (PTA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HAGEROTT
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 1:2334 AUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7690
Mailing Address - Country:US
Mailing Address - Phone:772-643-1600
Mailing Address - Fax:
Practice Address - Street 1:1099 W TOWN PKWY
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3845
Practice Address - Country:US
Practice Address - Phone:407-865-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant