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General NPI Number Information
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NPI Number | 1184512337
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Entity Type | Individual
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Provider Name | NIYA BRACKETT PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 910 E SOUTHLAKE BLVD STE 155
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6389
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Country | US
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Telephone | 817-421-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W MAIN ST APT 4045
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City | LEWISVILLE
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State | TX
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Zip | 75057-3786
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Country | US
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Telephone | 205-516-6151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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