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General NPI Number Information
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NPI Number | 1255963534
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Entity Type | Individual
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Provider Name | CULLEN BRODY RICHARDSON DPT
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Gender | Male
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3267 BEE CAVES RD STE 126
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City | AUSTIN
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State | TX
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Zip | 78746-6774
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Country | US
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Telephone | 512-202-8634
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Fax | 512-961-8907
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT6840
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1400556
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License Number State | TX
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