Individual
MR. BRYAN KELLY KINCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
632 WINDSOR WAY, VAN ALSTYNE, TX 75495
(903) 482-9324
(903) 482-9346
Mailing address
309 EQUINE LN, CELINA, TX 75009-4666
(806) 223-5757
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2052172
TX
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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