Provider Demographics
NPI:1891114369
Name:BRANTLEY, NOAH CHARLES (DPT)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:CHARLES
Last Name:BRANTLEY
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 1:208 LAMONT NORWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7181
Mailing Address - Country:US
Mailing Address - Phone:808-652-9140
Mailing Address - Fax:
Practice Address - Street 1:2460 OKA ST
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5308
Practice Address - Country:US
Practice Address - Phone:808-828-0030
Practice Address - Fax:808-828-0119
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT3794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist