Provider Demographics
NPI:1598882888
Name:BRALY, MISTY MICHELLE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MICHELLE
Last Name:BRALY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1701
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-1701
Mailing Address - Country:US
Mailing Address - Phone:325-437-1184
Mailing Address - Fax:325-437-3314
Practice Address - Street 1:2617 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5109
Practice Address - Country:US
Practice Address - Phone:325-437-1184
Practice Address - Fax:325-437-3314
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist