Provider Demographics
NPI:1184512337
Name:BRACKETT, NIYA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NIYA
Middle Name:
Last Name:BRACKETT
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 1:400 W MAIN ST APT 4045
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3786
Mailing Address - Country:US
Mailing Address - Phone:205-516-6151
Mailing Address - Fax:
Practice Address - Street 1:910 E SOUTHLAKE BLVD STE 155
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6389
Practice Address - Country:US
Practice Address - Phone:817-421-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist