Provider Demographics
NPI:1124121736
Name:HECTOR-REID, BRENDA DIANN (PT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DIANN
Last Name:HECTOR-REID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-2721
Mailing Address - Country:US
Mailing Address - Phone:903-832-8946
Mailing Address - Fax:903-793-1203
Practice Address - Street 1:1315 WALNUT
Practice Address - Street 2:TEMPLE MEMORIAL REHAB CTR
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:903-793-1203
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041200225100000X, 2251P0200X
AR630225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80091TOtherBCBS
AR98947OtherBCBS