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General NPI Number Information
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NPI Number | 1205068301
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Entity Type | Individual
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Provider Name | BRANDON MICHAEL JAYNE MSPT
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Gender | Male
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Dates
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Enumeration Date | 08/23/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 165 S MEMORIAL HWY SUITE 2C
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City | TRUCKSVILLE
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State | PA
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Zip | 18708-1418
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Country | US
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Telephone | 570-575-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 165 S MEMORIAL HWY SUITE 2C
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City | TRUCKSVILLE
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State | PA
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Zip | 18708-1418
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Country | US
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Telephone | 570-575-6064
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0002506
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License Number State | DE
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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 | PT020216
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License Number State | PA
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