Provider Demographics
NPI:1457478307
Name:MOFFATT, BRANDE (MPT)
Entity Type:Individual
Prefix:
First Name:BRANDE
Middle Name:
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2433
Mailing Address - Country:US
Mailing Address - Phone:530-242-1728
Mailing Address - Fax:530-242-1768
Practice Address - Street 1:2139 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-242-1728
Practice Address - Fax:530-242-1768
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT1248530Medicare ID - Type UnspecifiedMEDICARE NUMBER