Basic Information
| Provider Information | |||||||||
| NPI: | 1265586077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDING | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 203968 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787203968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124671100 | ||||||||
| FaxNumber: | 5124671101 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 DISCOVERY BLVD | ||||||||
| Address2: | STE 510 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786132287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124671100 | ||||||||
| FaxNumber: | 5124671101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3102893 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3102893 | 01 | TX | PT LICENSE TEXAS | OTHER |