Provider Demographics
NPI:1902578438
Name:JONES, BRANDON SCOTT (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SCOTT
Last Name:JONES
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 1:11660 CHURCH ST APT 748
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8962
Mailing Address - Country:US
Mailing Address - Phone:909-346-5111
Mailing Address - Fax:
Practice Address - Street 1:2419 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1185
Practice Address - Country:US
Practice Address - Phone:909-614-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist