Individual
BRYAN FEDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3817 STAGG DR, BEAUMONT, TX 77701-3717
(409) 866-0856
Mailing address
3817 STAGG DR, BEAUMONT, TX 77701-3717
(409) 866-0856
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2133910
TX
Other
Enumeration date
11/10/2017
Last updated
11/10/2017
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