Provider Demographics
NPI:1205946464
Name:BROMAN, BARRY A (MSPT)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:BROMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 WILLIAMS TRACE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4513
Mailing Address - Country:US
Mailing Address - Phone:281-980-2997
Mailing Address - Fax:281-980-0142
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4513
Practice Address - Country:US
Practice Address - Phone:281-980-2997
Practice Address - Fax:281-980-0142
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83763EOtherBCBS
TX83763EOtherBCBS