Provider Demographics
NPI:1750683942
Name:TELESMANIC, BRANDON NEIL (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:NEIL
Last Name:TELESMANIC
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 1:119 34TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3009
Mailing Address - Country:US
Mailing Address - Phone:559-260-1059
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE A201
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5949
Practice Address - Country:US
Practice Address - Phone:714-540-6792
Practice Address - Fax:714-540-6794
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist