Provider Demographics
NPI:1245886845
Name:GAUTIER, BRANDON CHRISTOPHER
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHRISTOPHER
Last Name:GAUTIER
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 1:3135 GRAND AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-6115
Mailing Address - Country:US
Mailing Address - Phone:302-419-4269
Mailing Address - Fax:
Practice Address - Street 1:3135 GRAND AVE APT 207
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-6115
Practice Address - Country:US
Practice Address - Phone:302-419-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer