Healthcare Provider Details

I. General information

NPI: 1053022467
Provider Name (Legal Business Name): BRANDE MOFFATT PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 OLD EUREKA WAY STE 1K
REDDING CA
96001-0228
US

IV. Provider business mailing address

2701 OLD EUREKA WAY STE 1K
REDDING CA
96001-0228
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-1728
  • Fax: 530-242-1768
Mailing address:
  • Phone: 530-242-1728
  • Fax: 530-242-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDE MOFFATT
Title or Position: PRESIDENT/CEO
Credential: PT
Phone: 530-242-1728