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General NPI Number Information
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NPI Number | 1669911624
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Entity Type | Individual
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Provider Name | BRYAN MUENCH PT, MPT, PCS
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Gender | Male
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 22452 COUNTY ROAD 3107
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City | GLADEWATER
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State | TX
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Zip | 75647-9690
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Country | US
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Telephone | 903-985-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 22452 COUNTY ROAD 3107
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City | GLADEWATER
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State | TX
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Zip | 75647-9690
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Country | US
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Telephone | 903-985-1098
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1143964
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License Number State | TX
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