Provider Demographics
NPI:1336590983
Name:HOLLAND, BRANDON SR
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:HOLLAND
Suffix:SR
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 1:16726 CHOWNING CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4607
Mailing Address - Country:US
Mailing Address - Phone:443-865-4473
Mailing Address - Fax:
Practice Address - Street 1:16726 CHOWNING CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4607
Practice Address - Country:US
Practice Address - Phone:443-865-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260011522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer