Basic Information
| Provider Information | |||||||||
| NPI: | 1093223687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURBER | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | CHASE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 MANNSFIELD CRESCENT WAY UNIT A | ||||||||
| Address2: | |||||||||
| City: | PITTSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273128880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767809343 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3475 ERWIN RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277050005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196811656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2018 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.