Provider Demographics
NPI:1215591714
Name:CARESTIA, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:CARESTIA
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 1:2735 STREET RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2810
Mailing Address - Country:US
Mailing Address - Phone:267-523-8866
Mailing Address - Fax:
Practice Address - Street 1:2735 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2810
Practice Address - Country:US
Practice Address - Phone:267-523-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2025-01-02
Deactivation Date:2019-08-14
Deactivation Code:
Reactivation Date:2019-08-21
Provider Licenses
StateLicense IDTaxonomies
PADAPT006173225100000X
VA2305213094225100000X
390200000X
PAPT032683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program