Healthcare Provider Details

I. General information

NPI: 1346027760
Provider Name (Legal Business Name): BRANDON TAYLOR PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20639 KUYKENDAHL RD
SPRING TX
77379-3586
US

IV. Provider business mailing address

9322 HIDDEN CT
MAGNOLIA TX
77354-5853
US

V. Phone/Fax

Practice location:
  • Phone: 832-698-0111
  • Fax:
Mailing address:
  • Phone: 801-372-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3131926
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: