Provider Demographics
NPI:1679211411
Name:PHAM, BRIAN A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:PHAM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4366
Mailing Address - Country:US
Mailing Address - Phone:281-916-6575
Mailing Address - Fax:281-916-6585
Practice Address - Street 1:3221 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4366
Practice Address - Country:US
Practice Address - Phone:281-916-6575
Practice Address - Fax:281-916-6585
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1361430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist