Provider Demographics
NPI:1205871100
Name:ANTHONY, BRANDI M (PT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:M
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S CLAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-6422
Mailing Address - Country:US
Mailing Address - Phone:972-878-0503
Mailing Address - Fax:972-878-6219
Practice Address - Street 1:1101 S CLAY ST STE B
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6422
Practice Address - Country:US
Practice Address - Phone:972-878-0503
Practice Address - Fax:972-878-6219
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3054Medicare PIN