Healthcare Provider Details

I. General information

NPI: 1881928331
Provider Name (Legal Business Name): MR. SCOTT PHILIP BRANSDORF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 N FEDERAL HWY
POMPANO BEACH FL
33062-3705
US

IV. Provider business mailing address

1290 N FEDERAL HWY
POMPANO BEACH FL
33062-3705
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-9667
  • Fax: 954-941-9204
Mailing address:
  • Phone: 954-943-9667
  • Fax: 954-941-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: