Provider Demographics
NPI:1467756635
Name:POUSO, BRANDY (PT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:POUSO
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 1:3221 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6452
Mailing Address - Country:US
Mailing Address - Phone:941-955-0630
Mailing Address - Fax:941-955-0894
Practice Address - Street 1:3221 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6452
Practice Address - Country:US
Practice Address - Phone:941-955-0630
Practice Address - Fax:941-955-0894
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist