Provider Demographics
NPI:1801386503
Name:LAKES, BRANDO LYDELL (DPT, PT, OCS)
Entity Type:Individual
Prefix:
First Name:BRANDO
Middle Name:LYDELL
Last Name:LAKES
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Gender:M
Credentials:DPT, PT, OCS
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Mailing Address - Street 1:3656 JOHNSON AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1616
Mailing Address - Country:US
Mailing Address - Phone:760-819-1921
Mailing Address - Fax:929-810-3278
Practice Address - Street 1:3656 JOHNSON AVE APT 6G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1616
Practice Address - Country:US
Practice Address - Phone:760-819-1921
Practice Address - Fax:929-810-3278
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2022-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY042929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist