Healthcare Provider Details

I. General information

NPI: 1164450680
Provider Name (Legal Business Name): RUDY F BRANTLEY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 LAMPLIGHT LN
VIRGINIA BEACH VA
23452-6534
US

IV. Provider business mailing address

717 LAMPLIGHT LN
VIRGINIA BEACH VA
23452-6534
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax:
Mailing address:
  • Phone: 757-722-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2279G0305X
TaxonomyGeriatric Care Registered Respiratory Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code2279P3800X
TaxonomyPalliative/Hospice Registered Respiratory Therapist
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code2279P4000X
TaxonomyPatient Transport Registered Respiratory Therapist
License Number
License Number State
# 12
Primary TaxonomyY
Taxonomy Code2279S1500X
TaxonomySNF/Subacute Care Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: