Provider Demographics
NPI:1467631630
Name:BABB, BRANDON JOHN (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JOHN
Last Name:BABB
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 1:410 1/2 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2238
Mailing Address - Country:US
Mailing Address - Phone:269-687-9594
Mailing Address - Fax:269-687-9543
Practice Address - Street 1:410 1/2 N 2ND ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2238
Practice Address - Country:US
Practice Address - Phone:269-687-9594
Practice Address - Fax:269-687-9543
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009440A225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232410DMedicare PIN