Provider Demographics
NPI:1326206665
Name:FORD, BRANDON R (PT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:R
Last Name:FORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-2128
Mailing Address - Country:US
Mailing Address - Phone:325-554-7017
Mailing Address - Fax:
Practice Address - Street 1:1800 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2418
Practice Address - Country:US
Practice Address - Phone:325-365-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11571672251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology