Healthcare Provider Details

I. General information

NPI: 1487496584
Provider Name (Legal Business Name): BRAXTEN PILAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 W ILLINOIS AVE
MIDLAND TX
79701-6337
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 432-687-0235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1397688
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: