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NPI Code Detail

MEDICARE: MS. JOLEEN RENEE BRANDON MPT

MEDICARE: MS. JOLEEN RENEE BRANDON MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist12568NC

General Provider Information

NPI Number : 1609179126
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JOLEEN RENEE BRANDON MPT
Provider Business Mailing Address
First Line : 400 JOHNSON RIDGE MEDICAL PARK
Second Line :
City : ELKIN
State : NC
Zip : 28621-2447
Country : US
Telephone Number : 336-786-2664
Fax Number : 336-786-9153
Provider Business Practice Location Address
First Line : 2210 RIDGE CREST LN
Second Line :
City : MOUNT AIRY
State : NC
Zip : 27030-2483
Country : US
Telephone Number : 336-786-2664
Fax Number : 336-786-9153
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2010
Last Update Date : 04/28/2017

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