Individual
KEVIN BRANSCUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9089 CLAIREMONT MESA BLVD STE 200, SAN DIEGO, CA 92123-1225
(870) 373-0606
Mailing address
PO BOX 682, CALICO ROCK, AR 72519-0682
(870) 373-0606
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT 40323
CA
2251X0800X
Orthopedic Physical Therapist
PT 40323
CA
Other
Enumeration date
08/29/2014
Last updated
08/29/2014
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