Provider Demographics
NPI:1992189955
Name:JONES, BRANDY ELLYN (LAT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ELLYN
Last Name:JONES
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 GLENBAY CT
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-7803
Mailing Address - Country:US
Mailing Address - Phone:281-639-8745
Mailing Address - Fax:
Practice Address - Street 1:23411 FM 2090 RD
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-6211
Practice Address - Country:US
Practice Address - Phone:281-689-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLAT41942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer