Provider Demographics
NPI:1497467260
Name:BYKOWSKI, BRANDON (LMT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BYKOWSKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BROKEN LANCE RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8800
Mailing Address - Country:US
Mailing Address - Phone:586-292-2906
Mailing Address - Fax:
Practice Address - Street 1:3816 BROWNS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3927
Practice Address - Country:US
Practice Address - Phone:678-780-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist