Provider Demographics
NPI:1831929462
Name:BOLLING, BRANDYN K (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRANDYN
Middle Name:K
Last Name:BOLLING
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 FAWN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5003
Mailing Address - Country:US
Mailing Address - Phone:214-385-1753
Mailing Address - Fax:
Practice Address - Street 1:747 FRONTAGE RD
Practice Address - Street 2:STE B-200
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-290-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist