Provider Demographics
NPI:1720717051
Name:TIRADO, BRANDI (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:TIRADO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1447
Mailing Address - Country:US
Mailing Address - Phone:575-635-0644
Mailing Address - Fax:
Practice Address - Street 1:2307 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4539
Practice Address - Country:US
Practice Address - Phone:814-528-5667
Practice Address - Fax:814-528-5064
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019798225100000X
PAPT030416225100000X
MD29825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT019798OtherPHYSICAL THERAPY LICENSE NUMBER
PAPT030416OtherPHYSICAL THERAPY LICENSE NUMBER