Healthcare Provider Details

I. General information

NPI: 1093223687
Provider Name (Legal Business Name): BRANDON CHASE SURBER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 ERWIN RD
DURHAM NC
27705-0005
US

IV. Provider business mailing address

113 MANNSFIELD CRESCENT WAY UNIT A
PITTSBORO NC
27312-8880
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-1656
  • Fax:
Mailing address:
  • Phone: 276-780-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: