Provider Demographics
NPI:1437337011
Name:LAMBIE, BRANDON WARD (PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:WARD
Last Name:LAMBIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 IVY LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1946
Mailing Address - Country:US
Mailing Address - Phone:903-295-1184
Mailing Address - Fax:
Practice Address - Street 1:103 W LOOP 281
Practice Address - Street 2:SUITE 800
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4653
Practice Address - Country:US
Practice Address - Phone:903-315-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist