Provider Demographics
NPI:1841300746
Name:SLAUGHTER, DAVID BRIAN (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2900 WADSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1231
Mailing Address - Country:US
Mailing Address - Phone:512-944-6401
Mailing Address - Fax:512-268-1830
Practice Address - Street 1:5695 KYLE PKWY
Practice Address - Street 2:STE 140
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6442
Practice Address - Country:US
Practice Address - Phone:512-268-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX11350692251S0007X, 225400000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1135069OtherLICENSE #