Provider Demographics
NPI:1043432453
Name:DUFFIE, BRANDON CRAIG (DPT, ATC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:CRAIG
Last Name:DUFFIE
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SEAPORT LN UNIT 3328
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3785
Mailing Address - Country:US
Mailing Address - Phone:843-478-5478
Mailing Address - Fax:
Practice Address - Street 1:8 SAWGRASS RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2523
Practice Address - Country:US
Practice Address - Phone:843-406-9889
Practice Address - Fax:843-406-7889
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT3683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1097Medicaid
SC8317Medicare PIN