Provider Demographics
NPI:1922066430
Name:BARKER, BRANDON LEE (PT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:BARKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 TIDBALL DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7620
Mailing Address - Country:US
Mailing Address - Phone:817-741-7809
Mailing Address - Fax:
Practice Address - Street 1:3809 TIDBALL DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7620
Practice Address - Country:US
Practice Address - Phone:817-741-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist