Provider Demographics
NPI:1609345008
Name:BRANNAM, CHANDLER ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:ELIZABETH
Last Name:BRANNAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHANDLER
Other - Middle Name:ELIZABETH
Other - Last Name:ZEIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5068
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY # MC5068
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:319-505-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist