1144407735 NPI number — BREANNA GAYLE RONNANDER M.S., P.T.

Table of content: BREANNA GAYLE RONNANDER M.S., P.T. (NPI 1144407735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144407735 NPI number — BREANNA GAYLE RONNANDER M.S., P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RONNANDER
Provider First Name:
BREANNA
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144407735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11242 FM 1960 RD W
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77065-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-469-8163
Provider Business Mailing Address Fax Number:
281-469-5559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28341 TOMBALL PKWY
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-973-2197
Provider Business Practice Location Address Fax Number:
832-871-4266
Provider Enumeration Date:
01/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1178160 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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