Basic Information
| Provider Information | |||||||||
| NPI: | 1518282771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | MARCUS | ||||||||
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| Credential: | P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 DAVIS LN | ||||||||
| Address2: | APT 5503 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787485012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129442492 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3932 RANCH ROAD 620 S | ||||||||
| Address2: | STE A | ||||||||
| City: | BEE CAVE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787387177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124671100 | ||||||||
| FaxNumber: | 5124671101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2010 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1190372 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.