Provider Demographics
NPI:1760949069
Name:KINZLER, BRENDA LUANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LUANNE
Last Name:KINZLER
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 1:5701 TRACYNE DR
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4215
Mailing Address - Country:US
Mailing Address - Phone:817-797-0081
Mailing Address - Fax:
Practice Address - Street 1:965 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5845
Practice Address - Country:US
Practice Address - Phone:817-594-7636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1316144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist