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Individual
JEFFREY MICHAEL BRANDENBURG
Active
Individual
JEFFREY MICHAEL BRANDENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT010992L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT010992L
PHYSICAL THERAPY LICENSE
PA
Enumeration date
06/05/2017
Last updated
06/05/2017
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