Provider Demographics
NPI:1184720724
Name:CLOUD, BRANDON S (PT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:CLOUD
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:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:3615 HOSPITAL ST STE B
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4112
Practice Address - Country:US
Practice Address - Phone:228-215-2260
Practice Address - Fax:228-215-2261
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1033218524OtherGROUP NPI
MS09015077Medicaid
MS09015077Medicaid