Provider Demographics
NPI:1225630320
Name:WILTZ, BRIA
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:WILTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 TIMBER CREEK PLACE DR APT 1511
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6662
Mailing Address - Country:US
Mailing Address - Phone:832-237-6138
Mailing Address - Fax:
Practice Address - Street 1:5450 TIMBER CREEK PLACE DR APT 1511
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6662
Practice Address - Country:US
Practice Address - Phone:832-237-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist