Provider Demographics
NPI:1467850156
Name:STONEKING, BRANDON (PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:STONEKING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PARKWAY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3018
Mailing Address - Country:US
Mailing Address - Phone:609-883-7528
Mailing Address - Fax:609-883-5947
Practice Address - Street 1:1230 PARKWAY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3018
Practice Address - Country:US
Practice Address - Phone:609-883-7528
Practice Address - Fax:609-883-5947
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01373400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist