Provider Demographics
NPI:1235972183
Name:GEORGE, BRETT ALLEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:ALLEN
Last Name:GEORGE
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 1:2911 CENTRAL EXPY APT 9302
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2445
Mailing Address - Country:US
Mailing Address - Phone:913-369-5187
Mailing Address - Fax:
Practice Address - Street 1:1313 N TRAVIS ST STE 104
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5165
Practice Address - Country:US
Practice Address - Phone:469-963-1771
Practice Address - Fax:214-377-6243
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1393319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist