Provider Demographics
NPI:1538488408
Name:BRANDON, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BRANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 BRIDGE ST
Mailing Address - Street 2:SUITE 490
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2384
Mailing Address - Country:US
Mailing Address - Phone:817-446-5000
Mailing Address - Fax:
Practice Address - Street 1:5601 BRIDGE ST
Practice Address - Street 2:SUITE 490
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2384
Practice Address - Country:US
Practice Address - Phone:817-446-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2069343225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant