Healthcare Provider Details

I. General information

NPI: 1336436351
Provider Name (Legal Business Name): BRANDON H FREEMAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 CONGRESS ST SUITE 2
PORTLAND ME
04102-2715
US

IV. Provider business mailing address

959 CONGRESS ST SUITE 2
PORTLAND ME
04102-2715
US

V. Phone/Fax

Practice location:
  • Phone: 207-699-5600
  • Fax: 207-699-5588
Mailing address:
  • Phone: 207-699-5600
  • Fax: 207-699-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: