Individual
DR. BRANDON LEE MACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
JUNCTION S. HWY 63 & 6E, OUTPATIENT PHYSICAL THERAPY, KIRKSVILLE, MO 63501
(660) 785-1834
Mailing address
29559 KATYDID, LA PLATA, MO 63549-1136
(660) 332-4960
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2004021474
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
858341605
—
MO
Enumeration date
03/21/2006
Last updated
07/09/2007
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