Provider Demographics
NPI:1942391552
Name:BRANDEL, THERESA A (RPT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:BRANDEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2088
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-2088
Mailing Address - Country:US
Mailing Address - Phone:307-247-0843
Mailing Address - Fax:
Practice Address - Street 1:1300 E A ST STE 103
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2211
Practice Address - Country:US
Practice Address - Phone:307-266-1203
Practice Address - Fax:307-266-2051
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT 748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW10060Medicare ID - Type Unspecified