MEDICARE: BRYAN EASTON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	2183071	TX

General Provider Information

NPI Number	:	1164251377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN EASTON PTA

Provider Business Mailing Address
First Line	:	1500 ALTA VISTA DR
Second Line	:
City	:	ALVIN
State	:	TX
Zip	:	77511-3102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6444 CENTRAL CITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-2058
Country	:	US
Telephone Number	:	832-738-7619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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Directions to “ BRYAN EASTON PTA” Practice Location

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