Individual
BREANNA RANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12345 KATY FWY, HOUSTON, TX 77079-1503
(281) 679-5600
Mailing address
12345 KATY FWY, HOUSTON, TX 77079-1503
(281) 679-5600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1288990
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1288990
BCBS
TX
Enumeration date
04/06/2017
Last updated
07/09/2020
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