Provider Demographics
NPI:1659537579
Name:BRANTLEY, MARLENA L (PT)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:L
Last Name:BRANTLEY
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 1:11940 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2003
Mailing Address - Country:US
Mailing Address - Phone:770-754-0085
Mailing Address - Fax:770-754-9288
Practice Address - Street 1:11940 ALPHARETTA HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2003
Practice Address - Country:US
Practice Address - Phone:770-754-0085
Practice Address - Fax:770-754-9288
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist