Provider Demographics
NPI:1770047656
Name:COUFAL, SIERRA BROOKE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:BROOKE
Last Name:COUFAL
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 1:11251 HIGHWAY 36 N
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-6370
Mailing Address - Country:US
Mailing Address - Phone:979-251-2700
Mailing Address - Fax:
Practice Address - Street 1:763 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3573
Practice Address - Country:US
Practice Address - Phone:979-251-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2125737225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant