Healthcare Provider Details

I. General information

NPI: 1225603772
Provider Name (Legal Business Name): AMANDA CHRISTINE BRANDENBURG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA CHRISTINE LESIKAR

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DODSON ST
MIDLAND TX
79701-6334
US

IV. Provider business mailing address

301 DODSON ST
MIDLAND TX
79701-6334
US

V. Phone/Fax

Practice location:
  • Phone: 432-687-0235
  • Fax:
Mailing address:
  • Phone: 432-687-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1348427
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: