Active NPI
Brandon Michael Defeo, DPT
- Physical Medicine & Rehabilitation Physician
- Statesboro, GA
National Provider Identifier
1124331871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- PT010013
- Practice address
- 1499 Fair Rd
Statesboro, GA 30458-1683 - Phone
- (912) 486-1680
- Fax
- (912) 486-1680
- NPI assigned
- Jul 23, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | PT010013 | GA | Primary |
Addresses
Primary practice location
1499 Fair Rd
Statesboro, GA 30458-1683
Mailing address
128 Stonebrook Way
Statesboro, GA 30458-0286
Phone (912) 515-5821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT010013 | GA | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373846400000",
"number": "1124331871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 STONEBROOK WAY",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580286",
"telephone_number": "912-515-5821",
"fax_number": "912-351-2385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1499 FAIR RD",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304581683",
"telephone_number": "912-486-1680",
"fax_number": "912-486-1680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFEO",
"first_name": "BRANDON",
"middle_name": "MICHAEL",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-23",
"last_updated": "2013-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "GA",
"license": "PT010013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.