Healthcare Provider Details

I. General information

NPI: 1124121736
Provider Name (Legal Business Name): BRENDA DIANN HECTOR-REID PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WALNUT TEMPLE MEMORIAL REHAB CTR
TEXARKANA TX
75501
US

IV. Provider business mailing address

106 MELROSE DR
TEXARKANA TX
75501-2721
US

V. Phone/Fax

Practice location:
  • Phone: 903-794-2705
  • Fax: 903-793-1203
Mailing address:
  • Phone: 903-832-8946
  • Fax: 903-793-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1041200
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number630
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1041200
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number630
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: