Provider Demographics
NPI:1053340653
Name:BRANDON, KAREN R (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:BRANDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11374
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-1374
Mailing Address - Country:US
Mailing Address - Phone:909-799-6212
Mailing Address - Fax:909-799-8939
Practice Address - Street 1:11374 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3830
Practice Address - Country:US
Practice Address - Phone:909-799-6212
Practice Address - Fax:909-799-8939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist