Provider Demographics
NPI:1710249677
Name:KINNEY BRINKLEY, BECKY SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:SUE
Last Name:KINNEY BRINKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:BECKY
Other - Middle Name:SUE
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 W MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8027
Mailing Address - Country:US
Mailing Address - Phone:214-509-6961
Mailing Address - Fax:214-382-0943
Practice Address - Street 1:515 W MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8027
Practice Address - Country:US
Practice Address - Phone:214-509-6961
Practice Address - Fax:214-382-0943
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist