Healthcare Provider Details

I. General information

NPI: 1861908881
Provider Name (Legal Business Name): BRENDA LEE RIPLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 DAVIS LN STE 200B
AUSTIN TX
78749-4062
US

IV. Provider business mailing address

5301 DAVIS LN STE 200B
AUSTIN TX
78749-4062
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-5925
  • Fax:
Mailing address:
  • Phone: 512-345-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1299246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: