Healthcare Provider Details

I. General information

NPI: 1790168102
Provider Name (Legal Business Name): BRYAN HERMANN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ST JOSEPH PKWY SUITE 301
HOUSTON TX
77002-8233
US

IV. Provider business mailing address

1415 SAXONY LN
HOUSTON TX
77058-3444
US

V. Phone/Fax

Practice location:
  • Phone: 832-295-9700
  • Fax:
Mailing address:
  • Phone: 832-295-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT122540
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT122540
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMT122540
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT122540
License Number StateTX

VIII. Authorized Official

Name: BRYAN MICHAEL HERMANN
Title or Position: OWNER
Credential: LMT
Phone: 832-295-9700