Provider Demographics
NPI:1750862413
Name:BRANNEN, BRENNA LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:LYNN
Last Name:BRANNEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:LYNN
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1440 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1958
Mailing Address - Country:US
Mailing Address - Phone:830-816-5095
Mailing Address - Fax:830-816-5095
Practice Address - Street 1:1440 RIVER RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1958
Practice Address - Country:US
Practice Address - Phone:830-816-5095
Practice Address - Fax:830-816-5095
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105338225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant