Provider Demographics
NPI:1396977641
Name:BRANDL, RICHARD SCOTT (PTA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
Last Name:BRANDL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2108 W 27TH ST STE K
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3168
Practice Address - Country:US
Practice Address - Phone:785-856-0160
Practice Address - Fax:785-856-0212
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032386225200000X
KS14-02060225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant