Provider Demographics
NPI:1649435074
Name:BRANDON, NORMAN HARGROVE (PTA)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:HARGROVE
Last Name:BRANDON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35404 25TH AVE SW
Mailing Address - Street 2:APT. 4-304
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3358
Mailing Address - Country:US
Mailing Address - Phone:253-217-2778
Mailing Address - Fax:
Practice Address - Street 1:35404 25TH AVE SW
Practice Address - Street 2:APT. 4-304
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3358
Practice Address - Country:US
Practice Address - Phone:253-217-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant