MEDICARE: BRITTANY REAGAN DYAL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2043107	TX

General Provider Information

NPI Number	:	1487856969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY REAGAN DYAL PTA

Provider Business Mailing Address
First Line	:	25 BRIERCROFT OFFICE PARK
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-3011
Country	:	US
Telephone Number	:	806-795-7433
Fax Number	:	806-795-7407

Provider Business Practice Location Address
First Line	:	3223 S LOOP 289 STE 101
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-8312
Country	:	US
Telephone Number	:	806-792-5522
Fax Number	:	806-785-7582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/08/2007

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