Healthcare Provider Details

I. General information

NPI: 1447456801
Provider Name (Legal Business Name): BRIANA LEE HOSTAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S 5TH STREET
KNOX CITY TX
79529
US

IV. Provider business mailing address

703 N CHARLES ST
SEYMOUR TX
76380-1920
US

V. Phone/Fax

Practice location:
  • Phone: 940-657-3535
  • Fax:
Mailing address:
  • Phone: 940-889-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1159190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: