Provider Demographics
NPI:1427784594
Name:BRANDT, ZACHARY EDWARD (DPT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:EDWARD
Last Name:BRANDT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9512 DORCHESTER RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4305
Mailing Address - Country:US
Mailing Address - Phone:843-695-7970
Mailing Address - Fax:
Practice Address - Street 1:525 BEDFORD ST STE 5&6
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3187
Practice Address - Country:US
Practice Address - Phone:508-279-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MA27690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist