Provider Demographics
NPI:1316783988
Name:ROSS, BRANDON ELIAS (DPT, PT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ELIAS
Last Name:ROSS
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0179
Mailing Address - Country:US
Mailing Address - Phone:410-684-5642
Mailing Address - Fax:443-632-0521
Practice Address - Street 1:7468 CANDLEWOOD RD # H3
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-3211
Practice Address - Country:US
Practice Address - Phone:410-684-5642
Practice Address - Fax:443-632-0521
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD30055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist