Organization
BRAZOS VALLEY P.T., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GARY ALAN JOHNSON P.T. (CEO)
(979) 846-2878
Entity
Organization
Contact information
Practice address
1716 BRIARCREST DR, SUITE 101, BRYAN, TX 77802-2763
(979) 846-2878
(979) 846-2877
Mailing address
1716 BRIARCREST DR, SUITE 101, BRYAN, TX 77802-2763
(979) 846-2878
(979) 846-2877
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041JZ
BCBSGROUP OUTPATIENT P.T.
TX
01
—
8T1220
FEDERAL BCBS P.T.
TX
Enumeration date
04/04/2007
Last updated
08/22/2020
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