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General NPI Number Information
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NPI Number | 1003566951
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Entity Type | Individual
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Provider Name | BRANDON KENT MARET PTA
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Gender | Male
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 800 LANTERN CREST WAY
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City | SANTEE
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State | CA
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Zip | 92071-4646
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Country | US
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Telephone | 619-258-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 4656 1/2 GREENE ST
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City | SAN DIEGO
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State | CA
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Zip | 92107-1420
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Country | US
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Telephone | 908-377-6795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 49605
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License Number State | CA
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