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Individual
MR. BRANDON S BRACKEEN
Active
Individual
MR. BRANDON S BRACKEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., D.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07417R
LA
225100000X
Physical Therapist
Primary
1176972
TX
2251S0007X
Sports Physical Therapist
07417R
LA
2251S0007X
Sports Physical Therapist
1176972
TX
2251X0800X
Orthopedic Physical Therapist
07417R
LA
2251X0800X
Orthopedic Physical Therapist
1176972
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191399801
—
TX
01
—
8T8115
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
—
P00440642
RAILROAD MEDICARE PIN
TX
Enumeration date
09/26/2007
Last updated
06/01/2026
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