Provider Demographics
NPI:1992835623
Name:CHARLTON, BRANDYN SHANE (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRANDYN
Middle Name:SHANE
Last Name:CHARLTON
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ASHLEE LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-9774
Mailing Address - Country:US
Mailing Address - Phone:570-275-6735
Mailing Address - Fax:
Practice Address - Street 1:700 COLLEGE PLACE
Practice Address - Street 2:LYCOMING COLLEGE
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5192
Practice Address - Country:US
Practice Address - Phone:570-321-4271
Practice Address - Fax:570-321-4158
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001818A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer