Basic Information
| Provider Information | |||||||||
| NPI: | 1992360267 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KOSER | ||||||||
| FirstName: | BRENDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 DRAFT HORSE | ||||||||
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| City: | FISCHER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786231839 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 RANCH ROAD 3237 | ||||||||
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| City: | WIMBERLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786765311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128475540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2011805 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.