Provider Demographics
NPI:1275825739
Name:BRENDA ELIZABETH SHUNN
Entity Type:Organization
Organization Name:BRENDA ELIZABETH SHUNN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT, RMT
Authorized Official - Phone:512-707-7688
Mailing Address - Street 1:2111 DICKSON DR STE 22
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4788
Mailing Address - Country:US
Mailing Address - Phone:512-797-7688
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DR STE 22
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4788
Practice Address - Country:US
Practice Address - Phone:512-797-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty