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General NPI Number Information
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NPI Number | 1902416241
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Entity Type | Individual
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Provider Name | NIKOLA DO BRUNELLE-TRAN PT
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Gender | Male
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Dates
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Enumeration Date | 08/02/2020
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Last Update Date | 08/02/2020
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Provider Practice Location Address
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Address Line | 7414 E GRAND AVE APT 738
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City | DALLAS
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State | TX
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Zip | 75214-4253
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Country | US
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Telephone | 214-609-4929
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Fax |
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Provider Business Mailing Address
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Address Line | 7414 E GRAND AVE APT 738
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City | DALLAS
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State | TX
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Zip | 75214-4253
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Country | US
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Telephone | 214-609-4929
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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 | 1307269
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-4929
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13012
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 295213
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License Number State | CA
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