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General NPI Number Information
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NPI Number | 1801720800
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Entity Type | Individual
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Provider Name | ALYSSA NOEL BRANDON PTA
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Gender | Female
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Dates
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Enumeration Date | 06/12/2026
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Last Update Date | 06/12/2026
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Provider Practice Location Address
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Address Line | 601 STATE ROUTE 664 N
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City | LOGAN
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State | OH
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Zip | 43138-8541
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Country | US
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Telephone | 740-380-8284
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Fax |
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Provider Business Mailing Address
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Address Line | 13468 PLEASANT VALLEY RD
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City | ROCKBRIDGE
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State | OH
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Zip | 43149-9769
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Country | US
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Telephone | 740-279-9079
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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 | 09723
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License Number State | OH
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