Provider Demographics
NPI:1740674993
Name:POWERS, BRANDY (DPT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:RENEE
Other - Last Name:PULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 BALDWIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3364
Mailing Address - Country:US
Mailing Address - Phone:704-316-1900
Mailing Address - Fax:
Practice Address - Street 1:125 BALDWIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3364
Practice Address - Country:US
Practice Address - Phone:704-316-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist