Provider Demographics
NPI:1447456801
Name:HOSTAS, BRIANA LEE (PT)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:LEE
Last Name:HOSTAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-1920
Mailing Address - Country:US
Mailing Address - Phone:940-889-6285
Mailing Address - Fax:
Practice Address - Street 1:700 S 5TH STREET
Practice Address - Street 2:
Practice Address - City:KNOX CITY
Practice Address - State:TX
Practice Address - Zip Code:79529
Practice Address - Country:US
Practice Address - Phone:940-657-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist