Provider Demographics
NPI:1437365244
Name:OWEN, BRANDIE HUSE (PT, OPA-C)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:HUSE
Last Name:OWEN
Suffix:
Gender:F
Credentials:PT, OPA-C
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Other - First Name:
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Mailing Address - Street 1:15300 DUCK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3718
Mailing Address - Country:US
Mailing Address - Phone:469-878-9617
Mailing Address - Fax:
Practice Address - Street 1:1643 LANCASTER DR
Practice Address - Street 2:STE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3593
Practice Address - Country:US
Practice Address - Phone:817-329-2524
Practice Address - Fax:817-329-2685
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1142388225100000X
TX992363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical