Provider Demographics
NPI:1013604867
Name:ARCHIBALD, BRANDON SCOTT
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:ARCHIBALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY HILL DR
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-3038
Mailing Address - Country:US
Mailing Address - Phone:801-669-7583
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY HILL DR
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3038
Practice Address - Country:US
Practice Address - Phone:801-669-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260036842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer