Provider Demographics
NPI:1790274033
Name:DAVIS, BRIANA (PTA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:MARIE
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 N LOOP 336 W APT 715
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3467
Mailing Address - Country:US
Mailing Address - Phone:936-446-0825
Mailing Address - Fax:
Practice Address - Street 1:3400 N LOOP 336 W APT 715
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3467
Practice Address - Country:US
Practice Address - Phone:936-446-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2123011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation