Provider Demographics
NPI:1972017853
Name:PRICE, BRANDON MATTHEW (DPT,PHD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MATTHEW
Last Name:PRICE
Suffix:
Gender:M
Credentials:DPT,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PALOMA PT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6917
Mailing Address - Country:US
Mailing Address - Phone:512-948-5795
Mailing Address - Fax:
Practice Address - Street 1:105 PALOMA PT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6917
Practice Address - Country:US
Practice Address - Phone:512-948-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1163169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1163169OtherTEXAS PHYSICAL THERAPY BOARD