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General NPI Number Information
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NPI Number | 1306017629
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Entity Type | Individual
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Provider Name | CHRISTOPHER M BRANDT ATC, PTA
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Gender | Male
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 18109 PRINCE PHILIP DR SUITE 155
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City | OLNEY
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State | MD
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Zip | 20832-1519
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Country | US
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Telephone | 315-573-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 2004 PEACEFUL WAY APT P1
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City | ODENTON
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State | MD
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Zip | 21113-1071
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Country | US
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Telephone | 315-573-4920
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001833-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0000592
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A4063
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License Number State | MD
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