Provider Demographics
NPI:1871517714
Name:BRYSON, BRENDA SUE (PT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:BRYSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28604 INTERSTATE 10 W
Mailing Address - Street 2:UNIT 4
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9115
Mailing Address - Country:US
Mailing Address - Phone:830-431-0773
Mailing Address - Fax:830-265-4053
Practice Address - Street 1:2702 N LOOP 1604 E STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1706
Practice Address - Country:US
Practice Address - Phone:210-496-5588
Practice Address - Fax:210-496-5580
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist