Provider Demographics
NPI:1497267611
Name:BOWER, BRETT RUSSELL (PTA)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:RUSSELL
Last Name:BOWER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17615 CLOVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8220
Mailing Address - Country:US
Mailing Address - Phone:225-975-6930
Mailing Address - Fax:
Practice Address - Street 1:17615 CLOVERVIEW DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8220
Practice Address - Country:US
Practice Address - Phone:225-975-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2104999225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant