Provider Demographics
NPI:1821112616
Name:AMANTE, BRIGANI GARGOLLO (MD, PT)
Entity type:Individual
Prefix:DR
First Name:BRIGANI
Middle Name:GARGOLLO
Last Name:AMANTE
Suffix:
Gender:M
Credentials:MD, PT
Other - Prefix:
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Mailing Address - Street 1:25329 INTERSTATE 45 STE 129
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3439
Mailing Address - Country:US
Mailing Address - Phone:346-478-1222
Mailing Address - Fax:346-478-1222
Practice Address - Street 1:25329 INTERSTATE 45 STE 129
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3439
Practice Address - Country:US
Practice Address - Phone:464-781-2223
Practice Address - Fax:346-478-1222
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6732207Q00000X, 207R00000X
CODR.0056152207RN0300X
TX1168543225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program