Provider Demographics
NPI:1790827186
Name:BRANDALESI, GERSON
Entity Type:Individual
Prefix:
First Name:GERSON
Middle Name:
Last Name:BRANDALESI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GERSON
Other - Middle Name:ANTONIO
Other - Last Name:BRANDALESI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5735 PARKMOR RD
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1038
Mailing Address - Country:US
Mailing Address - Phone:940-453-2999
Mailing Address - Fax:
Practice Address - Street 1:5735 PARKMOR RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1038
Practice Address - Country:US
Practice Address - Phone:972-317-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist