Provider Demographics
NPI:1285242495
Name:BARANZINI, BRANDON JOSEPH (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOSEPH
Last Name:BARANZINI
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GOLF COURSE DR APT 215
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1789
Mailing Address - Country:US
Mailing Address - Phone:707-547-7522
Mailing Address - Fax:
Practice Address - Street 1:5430 COMMERCE BLVD STE 1D
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1639
Practice Address - Country:US
Practice Address - Phone:707-234-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist