Provider Demographics
NPI:1679513899
Name:BRANDON, STEPHANIE MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:263 SEABOARD LN STE 200
Mailing Address - Street 2:PO BOX 681478
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8245
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:119 SEABOARD LN
Practice Address - Street 2:SUITE 408
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8306
Practice Address - Country:US
Practice Address - Phone:615-778-9894
Practice Address - Fax:615-778-9843
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid
TN446631Medicare PIN