Provider Demographics
NPI:1487856969
Name:DYAL, BRITTANY REAGAN (PTA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:REAGAN
Last Name:DYAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:25 BRIERCROFT OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-3011
Mailing Address - Country:US
Mailing Address - Phone:806-795-7433
Mailing Address - Fax:806-795-7407
Practice Address - Street 1:3223 S LOOP 289 STE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-8312
Practice Address - Country:US
Practice Address - Phone:806-792-5522
Practice Address - Fax:806-785-7582
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2043107225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant