Healthcare Provider Details

I. General information

NPI: 1609674407
Provider Name (Legal Business Name): BRIANNA NICOLE CUELLAR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA NICOLE GARZA PT, DPT

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MAIN AVE STE 107
SAN ANTONIO TX
78205-1115
US

IV. Provider business mailing address

434 SHADYWOOD LN
SAN ANTONIO TX
78216-6814
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-7725
  • Fax:
Mailing address:
  • Phone: 956-393-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1348637
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: