Provider Demographics
NPI:1073344826
Name:WARRIOR, BRAYLON TERRELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRAYLON
Middle Name:TERRELL
Last Name:WARRIOR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413181 E 1080 RD
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-5029
Mailing Address - Country:US
Mailing Address - Phone:918-926-0578
Mailing Address - Fax:
Practice Address - Street 1:747 FRONTAGE RD
Practice Address - Street 2:SUITE B-200
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-920-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-23
Deactivation Date:2024-08-13
Deactivation Code:
Reactivation Date:2024-08-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist