Provider Demographics
NPI:1619070935
Name:SHUNN, BRENDA ELIZABETH (LPT, RMT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ELIZABETH
Last Name:SHUNN
Suffix:
Gender:F
Credentials:LPT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 DICKSON DR STE 22
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4788
Mailing Address - Country:US
Mailing Address - Phone:512-707-7688
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DR STE 22
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4788
Practice Address - Country:US
Practice Address - Phone:512-707-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1045847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659260OtherBCBS
TX659260OtherBCBS