Healthcare Provider Details

I. General information

NPI: 1649549064
Provider Name (Legal Business Name): BRANDON L FLIPPIN D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 W HORIZON RIDGE PKWY 205
HENDERSON NV
89052-5058
US

IV. Provider business mailing address

2930 W HORIZON RIDGE PKWY 205
HENDERSON NV
89052-5058
US

V. Phone/Fax

Practice location:
  • Phone: 702-597-8999
  • Fax: 702-597-8988
Mailing address:
  • Phone: 702-597-8999
  • Fax: 702-597-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2624
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: