Provider Demographics
NPI:1922062165
Name:BRANDON, BRYAN EUGENE (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:EUGENE
Last Name:BRANDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HIGH MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7890
Mailing Address - Country:US
Mailing Address - Phone:336-940-6415
Mailing Address - Fax:336-940-6410
Practice Address - Street 1:135 MEDICAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6651
Practice Address - Country:US
Practice Address - Phone:336-940-6416
Practice Address - Fax:336-940-6410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210626Medicaid
NC0281YOtherBCBS OF NC
NC85377OtherMEDCOST
NC2502821Medicare ID - Type UnspecifiedPROVIDER NUMBER