Provider Demographics
NPI:1174371587
Name:BROKESHOULDER, BRANDON LEE (DPT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:BROKESHOULDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PIPER ST STE C
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8263
Mailing Address - Country:US
Mailing Address - Phone:501-463-9057
Mailing Address - Fax:866-632-2934
Practice Address - Street 1:117 PIPER ST STE C
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8263
Practice Address - Country:US
Practice Address - Phone:501-463-9057
Practice Address - Fax:866-632-2934
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist