MEDICARE: TERI BRANNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA1543	AL

General Provider Information

NPI Number	:	1992103113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI BRANNON

Provider Business Mailing Address
First Line	:	1846 COUNTY ROAD 345
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-7101
Country	:	US
Telephone Number	:	256-777-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1846 COUNTY ROAD 345
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-7101
Country	:	US
Telephone Number	:	256-777-6250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	12/22/2014

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Directions to “ TERI BRANNON ” Practice Location

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