Provider Demographics
NPI:1457660490
Name:ZETROUER, BRANDI ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:ANNE
Last Name:ZETROUER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PAMPAS DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4031
Mailing Address - Country:US
Mailing Address - Phone:912-844-3227
Mailing Address - Fax:
Practice Address - Street 1:139 PAMPAS DR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4031
Practice Address - Country:US
Practice Address - Phone:912-844-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62972251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics