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General NPI Number Information
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NPI Number | 1912371188
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Entity Type | Individual
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Provider Name | BRANDON J PHELPS DPT
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Gender | Male
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 1501 OCOTILLO DR STE B
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City | EL CENTRO
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State | CA
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Zip | 92243
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Country | US
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Telephone | 760-679-0210
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Fax | 760-679-0213
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Provider Business Mailing Address
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Address Line | 317 N EL CAMINO REAL STE 210
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City | ENCINITAS
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State | CA
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Zip | 92024-2813
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Country | US
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Telephone | 760-337-1144
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Fax | 760-337-8259
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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 | 43358
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License Number State | CA
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