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General NPI Number Information
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NPI Number | 1538752464
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Entity Type | Individual
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Provider Name | BRANDON MARCUS ANDERSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 2650 SAINT MATTHEWS RD
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City | ORANGEBURG
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State | SC
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Zip | 29118-1344
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Country | US
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Telephone | 803-536-5509
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Fax | 803-536-4104
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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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 | P20094
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License Number State | NC
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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 |
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License Number State | SC
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