Provider Demographics
NPI:1649587544
Name:IRONS, BRANDON (PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:IRONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 RUFFIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1804
Mailing Address - Country:US
Mailing Address - Phone:858-380-4185
Mailing Address - Fax:858-609-6651
Practice Address - Street 1:3939 RUFFIN RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1804
Practice Address - Country:US
Practice Address - Phone:858-380-4185
Practice Address - Fax:858-609-6651
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1352617225100000X
CAPT 37061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEO210ZMedicare PIN