Provider Demographics
NPI:1891816419
Name:BRASSEAUX, JEAN D (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:D
Last Name:BRASSEAUX
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4201
Mailing Address - Country:US
Mailing Address - Phone:318-564-2213
Mailing Address - Fax:
Practice Address - Street 1:1700 UHLAND DR
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4201
Practice Address - Country:US
Practice Address - Phone:318-564-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22066225100000X
TX1253330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist