Provider Demographics
NPI:1033803556
Name:BREARD, ELIZABETH BLAIR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:BREARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OAK LAWN AVE STE 650
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4383
Mailing Address - Country:US
Mailing Address - Phone:214-528-3378
Mailing Address - Fax:
Practice Address - Street 1:8070 PARK LN STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6439
Practice Address - Country:US
Practice Address - Phone:469-372-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13759032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic