Healthcare Provider Details

I. General information

NPI: 1033803556
Provider Name (Legal Business Name): ELIZABETH BLAIR BREARD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 PARK LN STE 130
DALLAS TX
75231-6439
US

IV. Provider business mailing address

3500 OAK LAWN AVE STE 240
DALLAS TX
75219-4329
US

V. Phone/Fax

Practice location:
  • Phone: 469-372-0021
  • Fax:
Mailing address:
  • Phone: 214-528-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1375903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: