Individual
BRANDON LEE PECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
630 W WOODLAWN AVE, SAN ANTONIO, TX 78212-3348
(210) 736-3177
Mailing address
9861 VICTORIA LN, BOERNE, TX 78006-5140
(210) 627-5084
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2177205
TX
Other
Enumeration date
08/03/2023
Last updated
08/03/2023
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