Provider Demographics
NPI:1346637501
Name:OWEN, BRANDON TRENT (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:TRENT
Last Name:OWEN
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11468 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-4923
Mailing Address - Country:US
Mailing Address - Phone:434-251-1334
Mailing Address - Fax:
Practice Address - Street 1:200 MILITARY DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-4658
Practice Address - Country:US
Practice Address - Phone:434-432-2481
Practice Address - Fax:434-432-3129
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260016932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer