Provider Demographics
NPI:1245713858
Name:GATHING, LAILA BREANA (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAILA
Middle Name:BREANA
Last Name:GATHING
Suffix:
Gender:
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LAILA
Other - Middle Name:BREANA
Other - Last Name:JASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:800 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3503
Mailing Address - Country:US
Mailing Address - Phone:972-420-8543
Mailing Address - Fax:
Practice Address - Street 1:800 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-3503
Practice Address - Country:US
Practice Address - Phone:972-420-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1363085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist