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NPI Code Detail

MEDICARE: MISS BRENNA SUZANNE MOORE DPT

MEDICARE: MISS BRENNA SUZANNE MOORE DPT
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1689536518
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS BRENNA SUZANNE MOORE DPT
Provider Business Mailing Address
First Line : 4203 MEADOW DR
Second Line :
City : GRAPEVINE
State : TX
Zip : 76051-6565
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 BOOTH CALLOWAY RD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-7371
Country : US
Telephone Number : 817-255-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ MISS BRENNA SUZANNE MOORE DPT” Practice Location

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