Healthcare Provider Details

I. General information

NPI: 1285459909
Provider Name (Legal Business Name): BRIAN GILL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 RAYFORD RD STE 300
SPRING TX
77386-1707
US

IV. Provider business mailing address

912 LINDEN BLVD APT 1C
BROOKLYN NY
11203-3758
US

V. Phone/Fax

Practice location:
  • Phone: 281-863-9944
  • Fax:
Mailing address:
  • Phone: 347-465-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1402799
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: