Provider Demographics
NPI:1639110430
Name:SCULLY, BRIAN C (EDD MSPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:SCULLY
Suffix:
Gender:M
Credentials:EDD MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10321 KATY FRWY
Mailing Address - Street 2:STE D-2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:713-365-9338
Mailing Address - Fax:713-365-9488
Practice Address - Street 1:10321 KATY FRWY
Practice Address - Street 2:STE D-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-365-9338
Practice Address - Fax:713-365-9488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist