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NPI Code Detail

MEDICARE: MICHELLE LEIGH BROUILLARD MPT

MEDICARE: MICHELLE LEIGH BROUILLARD MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1145332TX

General Provider Information

NPI Number : 1932329877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LEIGH BROUILLARD MPT
Provider Business Mailing Address
First Line : 9587 HIGHEDGE DR
Second Line :
City : DALLAS
State : TX
Zip : 75238-2534
Country : US
Telephone Number : 409-939-0312
Fax Number :
Provider Business Practice Location Address
First Line : 9441 LYNDON B JOHNSON FWY STE 101
Second Line :
City : DALLAS
State : TX
Zip : 75243-4566
Country : US
Telephone Number : 214-575-9820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2007
Last Update Date : 07/08/2007

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Directions to “ MICHELLE LEIGH BROUILLARD MPT” Practice Location

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