Provider Demographics
NPI:1578646253
Name:DAVIS, BRANT R (PT)
Entity Type:Individual
Prefix:MR
First Name:BRANT
Middle Name:R
Last Name:DAVIS
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Gender:M
Credentials:PT
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Mailing Address - Street 1:4323 N JOSEY LN
Mailing Address - Street 2:STE 307
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4630
Mailing Address - Country:US
Mailing Address - Phone:972-394-0118
Mailing Address - Fax:972-394-1058
Practice Address - Street 1:4323 N JOSEY LN
Practice Address - Street 2:STE 307
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4630
Practice Address - Country:US
Practice Address - Phone:972-394-0118
Practice Address - Fax:972-394-1058
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1105963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84P587Medicare PIN