Basic Information
| Provider Information | |||||||||
| NPI: | 1972932663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TABBUTT | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1613 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358758 | ||||||||
| FaxNumber: | 9195353271 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 NC 55 HWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275198426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192902799 | ||||||||
| FaxNumber: | 9192902532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 03/12/2015 | ||||||||
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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 | 14435 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.