Provider Demographics
NPI:1780081497
Name:TAYS, BRANDON SHANE (DPT)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SHANE
Last Name:TAYS
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 1:695 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3738
Mailing Address - Country:US
Mailing Address - Phone:770-386-6300
Mailing Address - Fax:770-382-0791
Practice Address - Street 1:695 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3738
Practice Address - Country:US
Practice Address - Phone:770-386-6300
Practice Address - Fax:770-382-0791
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT8541225100000X
ALPTH5694225100000X
GAPT011896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517399Medicaid