Provider Demographics
NPI:1952999393
Name:HOOVER, BRANDON HOOVER
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:HOOVER
Last Name:HOOVER
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 1:1702 W 31ST CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2819
Mailing Address - Country:US
Mailing Address - Phone:850-527-0573
Mailing Address - Fax:
Practice Address - Street 1:1702 W 31ST CT
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2819
Practice Address - Country:US
Practice Address - Phone:850-527-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist