Healthcare Provider Details

I. General information

NPI: 1780883520
Provider Name (Legal Business Name): BRANDON MICHAEL TRACHMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N MAIN ST
KINGFISHER OK
73750-2730
US

IV. Provider business mailing address

105 N MAIN ST
KINGFISHER OK
73750-2730
US

V. Phone/Fax

Practice location:
  • Phone: 405-375-5654
  • Fax: 405-375-5655
Mailing address:
  • Phone: 405-375-5654
  • Fax: 405-375-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4038
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: