Basic Information
| Provider Information | |||||||||
| NPI: | 1740302140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELANO | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 JAMECO MILL RD | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040748215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073965685 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 DAVIS POINT LN | ||||||||
| Address2: | |||||||||
| City: | CAPE ELIZABETH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041072620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077679773 | ||||||||
| FaxNumber: | 2075419212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 10/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT2417 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT2417 | 01 | ME | PHYSICAL THERAPY LICENSE | OTHER |