Provider Demographics
NPI:1194073171
Name:KING, BRANDAN JAMES (DPT)
Entity type:Individual
Prefix:
First Name:BRANDAN
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 CRANMER DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1310
Mailing Address - Country:US
Mailing Address - Phone:909-973-4504
Mailing Address - Fax:
Practice Address - Street 1:1446 CRANMER DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1310
Practice Address - Country:US
Practice Address - Phone:909-973-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic