Provider Demographics
NPI:1962653329
Name:MCDONOUGH, BRIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14814 S CANARY YELLOW CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6633
Mailing Address - Country:US
Mailing Address - Phone:832-515-8121
Mailing Address - Fax:832-201-9581
Practice Address - Street 1:24608 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3386
Practice Address - Country:US
Practice Address - Phone:832-515-8121
Practice Address - Fax:832-201-9581
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11987112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151183Medicare UPIN