Provider Demographics
NPI:1316129430
Name:BRASHEAR-BRISCOE, TERESA ALVE (PT)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ALVE
Last Name:BRASHEAR-BRISCOE
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 1:1406 CLOYNE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3743
Mailing Address - Country:US
Mailing Address - Phone:817-417-0010
Mailing Address - Fax:
Practice Address - Street 1:1406 CLOYNE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3743
Practice Address - Country:US
Practice Address - Phone:817-417-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist