Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1041200 | TX |
N | 225100000X | Physical Therapist | 630 | AR |
N | 2251P0200X | Physical Therapist - Pediatrics | 1041200 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 630 | AR |
NPI | 1124121736 |
---|---|
Provider Name | Mrs. Brenda Diann Hector-Reid |
First Address | Texarkana, TX 75501-2721 |
Second Address | Texarkana, TX 75501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80091T | BCBS (01) | TX |
98947 | BCBS (01) | AR |