Healthcare Provider Details

I. General information

NPI: 1184303620
Provider Name (Legal Business Name): BRANDON TAI HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 LAKE WOODLANDS DR UNIT F
SPRING TX
77382-2566
US

IV. Provider business mailing address

1560 LEAGUE LINE RD APT 7102
CONROE TX
77304-3481
US

V. Phone/Fax

Practice location:
  • Phone: 281-364-1122
  • Fax:
Mailing address:
  • Phone: 281-323-9827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: