Provider Demographics
NPI:1639770787
Name:SPALDING BRANNON, REBEKAH HERNANDEZ (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:HERNANDEZ
Last Name:SPALDING BRANNON
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 1:1616 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2774
Mailing Address - Country:US
Mailing Address - Phone:254-771-9003
Mailing Address - Fax:254-771-9006
Practice Address - Street 1:1616 AZALEA DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2774
Practice Address - Country:US
Practice Address - Phone:254-771-9003
Practice Address - Fax:254-771-9006
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1336212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist