Provider Demographics
NPI:1245984111
Name:BRABHAM, THOMAS DANIEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DANIEL
Last Name:BRABHAM
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 1:780 SAWDUST RD APT 231
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4152
Mailing Address - Country:US
Mailing Address - Phone:254-297-9986
Mailing Address - Fax:
Practice Address - Street 1:1803 W WHITE OAK TER STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3675
Practice Address - Country:US
Practice Address - Phone:936-494-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1357922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist