Provider Demographics
NPI:1699052571
Name:MASCARENAS, BRANDON PAUL (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:PAUL
Last Name:MASCARENAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 E 14TH AVE
Mailing Address - Street 2:APT.#6
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2538
Mailing Address - Country:US
Mailing Address - Phone:303-460-0329
Mailing Address - Fax:303-460-0387
Practice Address - Street 1:270 NW BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-215-9146
Practice Address - Fax:503-215-9149
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO113452251X0800X
OR600592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic