Provider Demographics
NPI:1588338149
Name:BRINSON, CORRYNA RENAE (LMT)
Entity type:Individual
Prefix:
First Name:CORRYNA
Middle Name:RENAE
Last Name:BRINSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13501 KATY FWY # 1640
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1305
Mailing Address - Country:US
Mailing Address - Phone:281-698-7126
Mailing Address - Fax:
Practice Address - Street 1:13501 KATY FWY # 1640
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1305
Practice Address - Country:US
Practice Address - Phone:281-698-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist