Provider Demographics
NPI:1467585331
Name:BRANDAY, KYLE (MSPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BRANDAY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRADLEY RD
Mailing Address - Street 2:SUITE #801
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2296
Mailing Address - Country:US
Mailing Address - Phone:203-389-4593
Mailing Address - Fax:203-389-4609
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE #801
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2296
Practice Address - Country:US
Practice Address - Phone:203-389-4593
Practice Address - Fax:203-389-4609
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT008058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080008058CT01OtherBLUE CROSS
CT080008058CT01OtherBLUE CROSS
CT650001386Medicare PIN