Healthcare Provider Details

I. General information

NPI: 1174217442
Provider Name (Legal Business Name): BRIELLE OKENFUSS DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 FIELDER NORTH PLZ
ARLINGTON TX
76012-2309
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 817-461-4257
  • Fax: 817-461-4865
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1394562
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016605
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: