1063625929 NPI number — DR. BRANDEN L MCDOWELL DPT, SCS

Table of content: DR. BRANDEN L MCDOWELL DPT, SCS (NPI 1063625929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063625929 NPI number — DR. BRANDEN L MCDOWELL DPT, SCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDOWELL
Provider First Name:
BRANDEN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT, SCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063625929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
184 N MAIN ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKENMUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48734-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-262-8500
Provider Business Mailing Address Fax Number:
989-262-8501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 N MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKENMUTH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48734-1255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-262-8500
Provider Business Practice Location Address Fax Number:
989-262-8501
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501011853 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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