Healthcare Provider Details

I. General information

NPI: 1750408019
Provider Name (Legal Business Name): MARY HOHL PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E 24TH ST
BRYAN TX
77803-5303
US

IV. Provider business mailing address

302 E 24TH ST
BRYAN TX
77803-5303
US

V. Phone/Fax

Practice location:
  • Phone: 979-822-6467
  • Fax: 979-821-9448
Mailing address:
  • Phone: 979-822-6467
  • Fax: 979-821-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1027993
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: