Healthcare Provider Details

I. General information

NPI: 1891114369
Provider Name (Legal Business Name): NOAH CHARLES BRANTLEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 OKA ST
KILAUEA HI
96754-5308
US

IV. Provider business mailing address

208 LAMONT NORWOOD RD
PITTSBORO NC
27312-7181
US

V. Phone/Fax

Practice location:
  • Phone: 808-828-0030
  • Fax: 808-828-0119
Mailing address:
  • Phone: 808-652-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT3794
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: