Provider Demographics
NPI:1386290344
Name:DAVIS, BRANDON (CRT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13022 FAIRACRES WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5479
Mailing Address - Country:US
Mailing Address - Phone:304-698-2918
Mailing Address - Fax:
Practice Address - Street 1:13022 FAIRACRES WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-5479
Practice Address - Country:US
Practice Address - Phone:304-698-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified