Provider Demographics
NPI:1841380912
Name:MARINO, BRANDON CHRISTOPHER (RPT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:CHRISTOPHER
Last Name:MARINO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8700 MELLMANOR DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3152
Mailing Address - Country:US
Mailing Address - Phone:619-464-1352
Mailing Address - Fax:619-464-7255
Practice Address - Street 1:8939 LA MESA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9057
Practice Address - Country:US
Practice Address - Phone:619-464-1352
Practice Address - Fax:619-464-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT25976OtherREG PHYSICAL THERAPIST