Provider Demographics
NPI:1710465612
Name:LEARNED, BRANDON (PT DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LEARNED
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2440
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:101 PHOENIX AVE STE 2D
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4470
Practice Address - Country:US
Practice Address - Phone:860-741-2541
Practice Address - Fax:860-745-5264
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2020-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT11920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11920OtherLICENSE