Provider Demographics
NPI:1467951681
Name:BRANSCUM, AUDREY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 KARLA DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4432
Mailing Address - Country:US
Mailing Address - Phone:682-552-1638
Mailing Address - Fax:
Practice Address - Street 1:1117 KARLA DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4432
Practice Address - Country:US
Practice Address - Phone:682-552-1638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1301740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1301740OtherTHE FEDERATION OF STATE BOARDS OF PHYSICAL THERAPY