Provider Demographics
NPI:1609605336
Name:GREEN, BRANDON M (DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NORTH ST STE C
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3825
Mailing Address - Country:US
Mailing Address - Phone:508-771-6685
Mailing Address - Fax:508-771-5774
Practice Address - Street 1:130 NORTH ST STE C
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3825
Practice Address - Country:US
Practice Address - Phone:508-771-6685
Practice Address - Fax:508-771-5774
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist