Healthcare Provider Details

I. General information

NPI: 1275443764
Provider Name (Legal Business Name): BRANDON BAHR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 W MAIN ST
CANTON NY
13617-1358
US

IV. Provider business mailing address

1001 WEST ST
CARTHAGE NY
13619-9703
US

V. Phone/Fax

Practice location:
  • Phone: 315-713-5003
  • Fax:
Mailing address:
  • Phone: 315-519-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: