Provider Demographics
NPI:1609179126
Name:BRANDON, JOLEEN RENEE (MPT)
Entity Type:Individual
Prefix:MS
First Name:JOLEEN
Middle Name:RENEE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 JOHNSON RIDGE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2447
Mailing Address - Country:US
Mailing Address - Phone:336-786-2664
Mailing Address - Fax:336-786-9153
Practice Address - Street 1:2210 RIDGE CREST LN
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2483
Practice Address - Country:US
Practice Address - Phone:336-786-2664
Practice Address - Fax:336-786-9153
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist