Provider Demographics
NPI:1891833091
Name:NOLT, BRANDON (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:NOLT
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DEGLER AVE
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KEYSTONE HALL ROOM 120
Practice Address - Street 2:KUTZTOWN UNIVERSITY
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530
Practice Address - Country:US
Practice Address - Phone:610-683-4085
Practice Address - Fax:610-683-4664
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer