Healthcare Provider Details

I. General information

NPI: 1780630855
Provider Name (Legal Business Name): JOHN MELVIN BRANDT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 HIGHWAY 2 E
RUGBY ND
58368
US

IV. Provider business mailing address

2975 HIGHWAY 2 E
RUGBY ND
58368
US

V. Phone/Fax

Practice location:
  • Phone: 701-776-5455
  • Fax: 701-776-5448
Mailing address:
  • Phone: 701-776-5261
  • Fax: 701-776-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1129
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: