Individual
BRANDON MARSHALL WADDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5433 STATE ROAD 46, SANFORD, FL 32771
(877) 322-5441
Mailing address
5433 STATE ROAD 46, SANFORD, FL 32771
(877) 322-5441
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
PTA22680
FL
Other
Enumeration date
09/08/2011
Last updated
09/08/2011
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