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General NPI Number Information
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NPI Number | 1083675763
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Entity Type | Individual
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Provider Name | JEREMY BRABANDT PT
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 221 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4907
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Country | US
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Telephone | 904-661-2790
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Fax | 904-661-2793
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Provider Business Mailing Address
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Address Line | 221 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4907
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Country | US
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Telephone | 904-661-2790
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Fax | 904-661-2793
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 002576
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 004749
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 011539
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 31733
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License Number State | FL
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