Provider Demographics
NPI:1760933444
Name:GILLETT, BRANDON DONALD (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:DONALD
Last Name:GILLETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1721 N LEE TREVINO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4563
Mailing Address - Country:US
Mailing Address - Phone:915-590-9424
Mailing Address - Fax:915-590-9044
Practice Address - Street 1:1721 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4563
Practice Address - Country:US
Practice Address - Phone:915-590-9424
Practice Address - Fax:915-590-9044
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4852225100000X
TX1249761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist