Provider Demographics
NPI:1992148928
Name:LEWELLING, BRANDON RAY (DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:RAY
Last Name:LEWELLING
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 1:1716 N HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8512
Mailing Address - Country:US
Mailing Address - Phone:405-281-5785
Mailing Address - Fax:405-281-5786
Practice Address - Street 1:1716 N HARPER RD
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8512
Practice Address - Country:US
Practice Address - Phone:405-281-5785
Practice Address - Fax:405-281-5786
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist