Healthcare Provider Details

I. General information

NPI: 1427798271
Provider Name (Legal Business Name): ANDREW M BRAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CHEYENNE CT
GRAFTON WI
53024-9368
US

IV. Provider business mailing address

2020 CHEYENNE CT
GRAFTON WI
53024-9368
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1075
  • Fax: 262-375-4975
Mailing address:
  • Phone: 262-375-1075
  • Fax: 262-375-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3262-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: