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Individual

BRANDON MATTHEW TODD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
1912 W POTTER DR APT A, BOISE, ID 83706-3149
(425) 231-9017
Mailing address
3208 132ND AVE SE, SNOHOMISH, WA 98290-9743

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7520
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT-7520
PHYSICAL THERAPY LICENSE
ID
Enumeration date
08/25/2021
Last updated
08/25/2021
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