Provider Demographics
NPI:1467179200
Name:BRANDES, JENNIFER LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BRANDES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 HILLBOLDT RD
Mailing Address - Street 2:
Mailing Address - City:CAT SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:78933-5046
Mailing Address - Country:US
Mailing Address - Phone:713-202-3367
Mailing Address - Fax:
Practice Address - Street 1:235 W PALM ST STE 111
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1300
Practice Address - Country:US
Practice Address - Phone:979-413-7330
Practice Address - Fax:979-413-7339
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist