Provider Demographics
NPI:1841792694
Name:SLOAN, BRANDON C (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:SLOAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:C
Other - Last Name:SLOAN-MONTALVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:48 PETER PARLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2997
Practice Address - Country:US
Practice Address - Phone:617-953-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty