Provider Demographics
NPI:1598885873
Name:SMITH, BRANDI L (PT, FAAOMPT, OCS)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, FAAOMPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 KINGSTON LACY BLVD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5318
Mailing Address - Country:US
Mailing Address - Phone:512-426-6593
Mailing Address - Fax:800-265-9314
Practice Address - Street 1:1704 KINGSTON LACY BLVD
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5318
Practice Address - Country:US
Practice Address - Phone:512-426-6593
Practice Address - Fax:008-265-9314
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161748225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L20409Medicare UPIN
TX8L20559Medicare UPIN
TXTXB120727Medicare PIN
TXTXB121034Medicare PIN