Provider Demographics
NPI:1750854691
Name:BRANCH, JANET ARLEEN
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ARLEEN
Last Name:BRANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PIEDMONT WAY
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-4005
Mailing Address - Country:US
Mailing Address - Phone:850-503-2963
Mailing Address - Fax:
Practice Address - Street 1:4500 PIEDMONT WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-4005
Practice Address - Country:US
Practice Address - Phone:850-503-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist