Provider Demographics
NPI:1972387421
Name:MAR, BRANDON R (PT,DPT NCS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:R
Last Name:MAR
Suffix:
Gender:M
Credentials:PT,DPT NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3327
Mailing Address - Country:US
Mailing Address - Phone:650-208-6091
Mailing Address - Fax:
Practice Address - Street 1:7 RIDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3327
Practice Address - Country:US
Practice Address - Phone:650-208-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology