Provider Demographics
NPI:1720311426
Name:REID, ALAN BRANDON (MS, ATC, LAT, PES)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:BRANDON
Last Name:REID
Suffix:
Gender:M
Credentials:MS, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 DUTCH BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4110
Mailing Address - Country:US
Mailing Address - Phone:817-321-0156
Mailing Address - Fax:
Practice Address - Street 1:7500 DUTCH BRANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4110
Practice Address - Country:US
Practice Address - Phone:817-321-0156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0603021972255A2300X
TXAT31832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060302197OtherNATA-BOC
TXAT3183OtherSTATE OF TEXAS LICENSE