Provider Demographics
NPI:1326636911
Name:SMYLY, BRIAN PAUL (DPT, PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:SMYLY
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LOS RIOS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7150 N GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2208
Practice Address - Country:US
Practice Address - Phone:972-497-2819
Practice Address - Fax:972-408-0879
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1342879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist