Provider Demographics
NPI:1679137095
Name:BRANHAM, DANNY ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:ANDREW
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MEDICAL PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7428
Mailing Address - Country:US
Mailing Address - Phone:606-632-1188
Mailing Address - Fax:
Practice Address - Street 1:149 MEDICAL PLAZA LN
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7428
Practice Address - Country:US
Practice Address - Phone:606-632-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist