| Doctor Name: | DR. BRANDON LEE MACK |
| NPI Number: | 1134188832 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.T. |
| License Number: | 2004021474 |
| Business Practice Address: | Junction S. Hwy 63 & 6e Outpatient Physical Therapy Kirksville, MO - 63501 |
| Business Phone Number: | 6607851834 |
| Business Fax Number: | |
| Mailing Address: | 29559 Katydid, LA PLATA |
| State: | MO |
| Postal Code: | 635491136 |
| Phone Number: | 6603324960 |
| Fax Number: | |
| NPI Enumeration Date: | 03/21/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 2004021474 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |