Healthcare Provider Details

I. General information

NPI: 1316835929
Provider Name (Legal Business Name): DESIREE PIERRE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DESIREE KIANNA BRADWELL DPT

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GREENWAY CT STE B&C
NEWNAN GA
30265-2326
US

IV. Provider business mailing address

40 GREENWAY CT STE B&C
NEWNAN GA
30265-2326
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-0195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42454
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: