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Individual

MR. HARRY FRED BRANDT JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
C.O.

Contact information

Practice address
1648 ELLIS ST, BOZEMAN, MT 59715-8810
(406) 585-1440
(406) 585-1438
Mailing address
4029 SUNSTONE ST, BOZEMAN, MT 59718-6184
(916) 849-7765

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
C12193
MD
222Z00000X
Orthotist
CCS
CA
222Z00000X
Orthotist
Primary
CO003610
VA
222Z00000X
Orthotist
ORT0000000131
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
50000
CALIFORNIA CHILDREN'S SERVICES (CCS), PANELED PROVIDER FOR ORTHOTICS
CA
01
C12193
BOARD OF CERTIFICATION/ACCREDITATION, INTERNATIONAL
MD
01
CO003610
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS AND PEDORTHICS
VA
01
ORT0000000131
LICENCED ORTHOTIST
TN
Enumeration date
06/28/2013
Last updated
01/16/2020
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