Provider Demographics
NPI:1255458014
Name:LUM, BRANDON M (MSPT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:M
Last Name:LUM
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SE PETIT LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5424
Mailing Address - Country:US
Mailing Address - Phone:772-335-5828
Mailing Address - Fax:
Practice Address - Street 1:4625 SAINT CROIX LN APT 1134
Practice Address - Street 2:APT. 1134
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3536
Practice Address - Country:US
Practice Address - Phone:617-780-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist