Individual
KEVIN BRANDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PES
Contact information
Practice address
62 JUNIPER ST, ISLIP, NY 11751-1213
(631) 327-1192
Mailing address
62 JUNIPER ST, ISLIP, NY 11751-1213
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002834-1
NY
Other
Enumeration date
08/05/2016
Last updated
08/05/2016
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