Basic Information
| Provider Information | |||||||||
| NPI: | 1891876256 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32336 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379302336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606722626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 CAVETT HILL LANE | ||||||||
| Address2: | |||||||||
| City: | FARRAGUT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657774000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7643 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.