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General NPI Number Information
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NPI Number | 1831106723
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Entity Type | Individual
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Provider Name | BRENTL GERARD HALEY PT
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 W CAMP WISDOM RD
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City | DALLAS
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State | TX
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Zip | 75232
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Country | US
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Telephone | 817-784-6323
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Fax | 817-784-6323
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Provider Business Mailing Address
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Address Line | PO BOX 180535
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City | ARLINGTON
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State | TX
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Zip | 76096
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Country | US
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Telephone | 817-784-6323
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Fax | 817-754-6323
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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 | 1014710
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License Number State |
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