Provider Demographics
NPI:1821766247
Name:THOMAS, BRANDON ALLEN (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALLEN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-6651
Mailing Address - Country:US
Mailing Address - Phone:610-533-7664
Mailing Address - Fax:
Practice Address - Street 1:22 WALMART PLZ
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1263
Practice Address - Country:US
Practice Address - Phone:908-847-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028858225100000X
NJ40QA01968500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist