Individual
BRANDO LYDELL LAKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT, PT, OCS
Contact information
Practice address
3656 JOHNSON AVE APT 6G, BRONX, NY 10463-1616
(760) 819-1921
(929) 810-3278
Mailing address
3656 JOHNSON AVE APT 6G, BRONX, NY 10463-1616
(760) 819-1921
(929) 810-3278
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
042929
NY
2251X0800X
Orthopedic Physical Therapist
Primary
042929
NY
Other
Enumeration date
05/17/2018
Last updated
04/18/2025
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