Provider Demographics
NPI:1609623016
Name:DEVALK, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:DEVALK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WOOD RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0622
Mailing Address - Country:US
Mailing Address - Phone:763-377-1687
Mailing Address - Fax:
Practice Address - Street 1:501 MARIN ST STE 205
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4266
Practice Address - Country:US
Practice Address - Phone:818-318-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist