Provider Demographics
NPI:1063898930
Name:BROOKS, BRANDY (DPT)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 IVY LN
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3763
Mailing Address - Country:US
Mailing Address - Phone:432-250-3492
Mailing Address - Fax:
Practice Address - Street 1:120 IVY LN
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3763
Practice Address - Country:US
Practice Address - Phone:432-250-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349399101Medicaid
TX434219YU7HMedicare PIN