Provider Demographics
NPI:1790168102
Name:BRYAN HERMANN
Entity Type:Organization
Organization Name:BRYAN HERMANN
Other - Org Name:CARIBBEAN MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:832-295-9700
Mailing Address - Street 1:1415 SAXONY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3444
Mailing Address - Country:US
Mailing Address - Phone:832-295-9700
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:832-295-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT122540172M00000X, 173C00000X, 174400000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty