Provider Demographics
NPI:1154581676
Name:BRANDON, JEANNE (PT)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BRANDON
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 1:109 SHULT DR
Mailing Address - Street 2:# 206
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3009
Mailing Address - Country:US
Mailing Address - Phone:979-732-8280
Mailing Address - Fax:979-732-9740
Practice Address - Street 1:6444 CENTRAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2058
Practice Address - Country:US
Practice Address - Phone:409-741-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08049728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist