Provider Demographics
NPI:1093972630
Name:COLQUITT, BRANDI M (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:M
Last Name:COLQUITT
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 1:2903 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1803
Mailing Address - Country:US
Mailing Address - Phone:903-663-6332
Mailing Address - Fax:903-663-6347
Practice Address - Street 1:2903 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1803
Practice Address - Country:US
Practice Address - Phone:903-663-6332
Practice Address - Fax:903-663-6347
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist