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NPI Code Detail

MEDICARE: BRANDON HERTRAMPF DPT

MEDICARE: BRANDON HERTRAMPF DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1194124594
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON HERTRAMPF DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2222
Fax Number : 630-759-6106
Provider Business Practice Location Address
First Line : 2330 N FARWELL AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4401
Country : US
Telephone Number : 414-220-9084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2014
Last Update Date : 03/28/2016

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