Provider Demographics
NPI:1881820116
Name:CARRELL, BRANDAN CHARLES (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:BRANDAN
Middle Name:CHARLES
Last Name:CARRELL
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 W HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3205
Mailing Address - Country:US
Mailing Address - Phone:541-852-3268
Mailing Address - Fax:
Practice Address - Street 1:8239 W HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-3205
Practice Address - Country:US
Practice Address - Phone:541-852-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist