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General NPI Number Information
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NPI Number | 1073299038
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Entity Type | Individual
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Provider Name | BILLY CLYDE BRYANT
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Gender | Male
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 30129 ROCK CREEK DR. SUITE 1000
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City | KINGWOOD
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State | TX
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Zip | 77339
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Country | US
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Telephone | 346-616-5154
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Fax |
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Provider Business Mailing Address
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Address Line | 11839 GREENMESA DR.
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City | HOUSTON
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State | TX
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Zip | 77044
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Country | US
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Telephone | 504-222-8680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT134164
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License Number State | TX
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