Provider Demographics
NPI:1518282771
Name:WILLIAMS, BRANDON MARCUS (PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MARCUS
Last Name:WILLIAMS
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 1:3101 DAVIS LN
Mailing Address - Street 2:APT 5503
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5012
Mailing Address - Country:US
Mailing Address - Phone:512-944-2492
Mailing Address - Fax:
Practice Address - Street 1:3932 RANCH ROAD 620 S
Practice Address - Street 2:STE A
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7177
Practice Address - Country:US
Practice Address - Phone:512-467-1100
Practice Address - Fax:512-467-1101
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist