Provider Demographics
NPI:1639958416
Name:BABBIDGE, BRANDON (CPTA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BABBIDGE
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HANOVER PL APT 4
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2030
Mailing Address - Country:US
Mailing Address - Phone:316-648-9137
Mailing Address - Fax:
Practice Address - Street 1:1601 SW LANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3135
Practice Address - Country:US
Practice Address - Phone:316-648-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-04110225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant