Provider Demographics
NPI:1770124612
Name:BRAZIL, ADAM G (PT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:G
Last Name:BRAZIL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 KINGWOOD EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2763
Mailing Address - Country:US
Mailing Address - Phone:346-522-2165
Mailing Address - Fax:346-522-2166
Practice Address - Street 1:215 KINGWOOD EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2763
Practice Address - Country:US
Practice Address - Phone:346-522-2165
Practice Address - Fax:346-522-2166
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1319215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist