Individual provider Active NPI

Brandon Coby Marrow, MSPT

  • Physical Therapist
  • Tyler, TX
National Provider Identifier
1447283320
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1124584 Issued in TX
Practice address
3110 Park Center Dr
Tyler, TX 75701-9215
Phone
(903) 593-9999
Fax
(903) 526-2679
NPI assigned
Jul 7, 2006
Last updated
Apr 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1124584 TX Primary

Addresses

Primary practice location

3110 Park Center Dr
Tyler, TX 75701-9215

Mailing address

PO Box 132929
Tyler, TX 75713-2929
Phone (903) 593-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060206000483 TX Practitioner - Physical Therapist in Private Practice 4486668829 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1124584TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
R2 Partners, LP Physical Therapist CurrentSince Oct 1, 2003 Accepting new patients
Longview Rehab Partners LP Past Accepting new patients
Longview Rehab Partners, LP Physical Therapist Past Accepting new patients
DRM Business Health, PLLC Past Accepting new patients
Functional Performance Analysts, L.P. Past Accepting new patients

Locations

3110 Park Center Dr
Tyler, TX 75701
Phone (903) 593-9999

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333497600000",
    "number": "1447283320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 132929",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757132929",
            "telephone_number": "903-593-9999",
            "fax_number": "903-526-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 PARK CENTER DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019215",
            "telephone_number": "903-593-9999",
            "fax_number": "903-526-2679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARROW",
        "first_name": "BRANDON",
        "middle_name": "COBY",
        "credential": "MSPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2012-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1124584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.