Provider Demographics
NPI:1215046453
Name:BRANDT, TIMOTHY
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BRANDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HIDDEN LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8010
Mailing Address - Country:US
Mailing Address - Phone:843-757-8038
Mailing Address - Fax:
Practice Address - Street 1:70 PENNINGTON DR
Practice Address - Street 2:#9
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6055
Practice Address - Country:US
Practice Address - Phone:843-815-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1549OtherLICENSE #