Provider Demographics
NPI:1811038789
Name:BARTH, BRANDY DANIELLE (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DANIELLE
Last Name:BARTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 MAJESTIC OAKS LN
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8324
Mailing Address - Country:US
Mailing Address - Phone:904-465-2934
Mailing Address - Fax:
Practice Address - Street 1:2879 MAJESTIC OAKS LN
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8324
Practice Address - Country:US
Practice Address - Phone:904-465-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist