Provider Demographics
NPI:1700199569
Name:MCGAUGHEY, BRANDON J (PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:MCGAUGHEY
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 1:117 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-3413
Mailing Address - Country:US
Mailing Address - Phone:719-626-1203
Mailing Address - Fax:765-494-2699
Practice Address - Street 1:117 OAK ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-3413
Practice Address - Country:US
Practice Address - Phone:719-626-1203
Practice Address - Fax:765-494-2699
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050103980A225100000X
COPTL.0013174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist