Healthcare Provider Details

I. General information

NPI: 1790692952
Provider Name (Legal Business Name): BRANDON K MIYASHIRO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 SUNSET BLVD STE 711
ROCKLIN CA
95765-4783
US

IV. Provider business mailing address

6884 COPPER GLEN CIR
ROSEVILLE CA
95678-3449
US

V. Phone/Fax

Practice location:
  • Phone: 916-435-3500
  • Fax:
Mailing address:
  • Phone: 916-749-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: