Provider Demographics
NPI:1457486052
Name:ROSS, BRANDI (MS, ATC, PES, CES)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, ATC, PES, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0382
Mailing Address - Country:US
Mailing Address - Phone:808-324-7727
Mailing Address - Fax:
Practice Address - Street 1:81-1043 KONAWAENA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8121
Practice Address - Country:US
Practice Address - Phone:808-323-4500
Practice Address - Fax:808-323-4515
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer