Provider Demographics
NPI:1295208056
Name:GOBLE, BRANDON HEATH (ATC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:HEATH
Last Name:GOBLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRANDYWINE DR NE APT L1
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-1843
Mailing Address - Country:US
Mailing Address - Phone:828-578-0230
Mailing Address - Fax:
Practice Address - Street 1:102 BRANDYWINE DR NE APT L1
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-1843
Practice Address - Country:US
Practice Address - Phone:828-578-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program