Basic Information
| Provider Information | |||||||||
| NPI: | 1518623313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILLARD | ||||||||
| FirstName: | BRIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17480 DALLAS PKWY STE 221 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752877361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692918500 | ||||||||
| FaxNumber: | 9723037020 | ||||||||
| Practice Location | |||||||||
| Address1: | 17480 DALLAS PKWY STE 221 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752877361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146235900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2166606 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.