Provider Demographics
NPI:1386058535
Name:NGUYEN, BREANNE R
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:R
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BREANNE
Other - Middle Name:N
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:7979 WURZBACH RD BLDG U.415
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4427
Mailing Address - Country:US
Mailing Address - Phone:210-450-1000
Mailing Address - Fax:210-450-2117
Practice Address - Street 1:7979 WURZBACH RD BLDG U.415
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-450-1000
Practice Address - Fax:210-450-2117
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist