Provider Demographics
NPI:1992104608
Name:RUMPH, BRANDON (ATC LAT EMT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:RUMPH
Suffix:
Gender:M
Credentials:ATC LAT EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NW 83RD ST
Mailing Address - Street 2:BUILDING V
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6210
Mailing Address - Country:US
Mailing Address - Phone:352-395-5549
Mailing Address - Fax:
Practice Address - Street 1:3000 NW 83RD ST
Practice Address - Street 2:BUILDING V
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6210
Practice Address - Country:US
Practice Address - Phone:352-395-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer