Provider Demographics
NPI:1114598026
Name:LAUREL, BRYAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:LAUREL
Suffix:
Gender:M
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 1:458 N HIGHWAY 67 STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2138
Mailing Address - Country:US
Mailing Address - Phone:469-272-3129
Mailing Address - Fax:469-272-3145
Practice Address - Street 1:458 N HIGHWAY 67 STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2138
Practice Address - Country:US
Practice Address - Phone:469-272-3129
Practice Address - Fax:469-272-3145
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist