Healthcare Provider Details

I. General information

NPI: 1215752514
Provider Name (Legal Business Name): BRANDON VU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 WILSHIRE BLVD STE 14B1
LOS ANGELES CA
90025-1547
US

IV. Provider business mailing address

11701 WILSHIRE BLVD STE 14B1
LOS ANGELES CA
90025-1547
US

V. Phone/Fax

Practice location:
  • Phone: 323-936-7525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: