Provider Demographics
NPI:1679046452
Name:BRISCOE-EAGLE, AMY LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:BRISCOE-EAGLE
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 1:9512 INDIGO BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2440
Mailing Address - Country:US
Mailing Address - Phone:512-917-0145
Mailing Address - Fax:
Practice Address - Street 1:4604 S LAMAR BLVD APT C109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1356
Practice Address - Country:US
Practice Address - Phone:512-917-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10982912251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics