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General NPI Number Information
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NPI Number | 1831578046
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Entity Type | Individual
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Provider Name | BRENDA KETTLE
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Gender | Female
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 3724 EXECUTIVE CENTER DR STE 220
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City | AUSTIN
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State | TX
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Zip | 78731-1638
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Country | US
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Telephone | 512-637-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 4549 CHESTNUT MEADOWS BND
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City | GEORGETOWN
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State | TX
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Zip | 78626-7143
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Country | US
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Telephone | 785-249-4146
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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 | 11-00911
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License Number State | KS
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