Provider Demographics
NPI:1720148901
Name:BRANDON, PATRICK K (PT DPT, CERT MDT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:K
Last Name:BRANDON
Suffix:
Gender:M
Credentials:PT DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9706 DARWAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6810
Mailing Address - Country:US
Mailing Address - Phone:915-256-3587
Mailing Address - Fax:
Practice Address - Street 1:1400 GEORGE DIETER DR STE 180
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7656
Practice Address - Country:US
Practice Address - Phone:915-234-2991
Practice Address - Fax:844-270-2164
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87726801Medicaid
TX650412OtherBLUE CROSS & BLUE SHIELD
TXR59441Medicare UPIN
TX87726801Medicaid