Provider Demographics
NPI:1780170357
Name:RUTTEN, BRANDON JOE
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JOE
Last Name:RUTTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E 29TH ST RM 105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-4160
Mailing Address - Country:US
Mailing Address - Phone:367-013-5923
Mailing Address - Fax:
Practice Address - Street 1:609 E 29TH ST RM 105
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-4160
Practice Address - Country:US
Practice Address - Phone:367-013-5923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-07
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist