Provider Demographics
NPI:1710429196
Name:SHRUM, BRANDON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SHRUM
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TURNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7822
Mailing Address - Country:US
Mailing Address - Phone:501-920-9081
Mailing Address - Fax:
Practice Address - Street 1:23 TURNBERRY LN
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7822
Practice Address - Country:US
Practice Address - Phone:501-920-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer