Provider Demographics
NPI:1174340152
Name:MABRY, IAN DANIEL (PT)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:DANIEL
Last Name:MABRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CLAUDELL
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6087
Mailing Address - Country:US
Mailing Address - Phone:512-803-5900
Mailing Address - Fax:
Practice Address - Street 1:951 LANDA ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6119
Practice Address - Country:US
Practice Address - Phone:830-327-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1397403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist