Provider Demographics
NPI:1659741098
Name:HALEY, BRIANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1803
Mailing Address - Country:US
Mailing Address - Phone:903-663-6332
Mailing Address - Fax:903-663-6347
Practice Address - Street 1:2903 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1803
Practice Address - Country:US
Practice Address - Phone:903-663-6332
Practice Address - Fax:903-663-6347
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist