Provider Demographics
NPI:1538129242
Name:BROWN, BRANDI B (PT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:B
Last Name:BROWN
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 1:5795 WIDEWATERS PKWY
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1832
Mailing Address - Country:US
Mailing Address - Phone:315-200-1800
Mailing Address - Fax:315-200-1800
Practice Address - Street 1:5795 WIDEWATERS PKWY
Practice Address - Street 2:SUITE 1A
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1832
Practice Address - Country:US
Practice Address - Phone:315-200-1800
Practice Address - Fax:315-200-1800
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA0836Medicare PIN
NYQ09672Medicare UPIN
NYRA0835Medicare PIN