Provider Demographics
NPI:1972932663
Name:TABBUTT, BRANDON FREDERICK (DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:FREDERICK
Last Name:TABBUTT
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 1:1613 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5928
Mailing Address - Country:US
Mailing Address - Phone:919-535-8758
Mailing Address - Fax:919-535-3271
Practice Address - Street 1:3100 NC 55 HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8426
Practice Address - Country:US
Practice Address - Phone:919-290-2799
Practice Address - Fax:919-290-2532
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist