Provider Demographics
NPI:1144606518
Name:BREAZEALE, WILLIAM DAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAN
Last Name:BREAZEALE
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 1:11617 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11617 N CENTRAL EXPY
Practice Address - Street 2:SUITE 140
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3800
Practice Address - Country:US
Practice Address - Phone:214-369-4123
Practice Address - Fax:214-369-2791
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12621222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538465901OtherNPI