Provider Demographics
NPI:1457833964
Name:ELMORE, BRANDON A (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:A
Last Name:ELMORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16230 SW 100TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5902
Mailing Address - Country:US
Mailing Address - Phone:803-378-6295
Mailing Address - Fax:
Practice Address - Street 1:13595 SW 134TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4579
Practice Address - Country:US
Practice Address - Phone:786-592-1190
Practice Address - Fax:786-732-2955
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist