Basic Information
| Provider Information | |||||||||
| NPI: | 1861982977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DITTBRENDER | ||||||||
| FirstName: | BRANDEE | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 301 | ||||||||
| Address2: | |||||||||
| City: | POPLAR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548640301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2184092929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3450 HULL RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326073260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522737001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2018 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AL5660 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.