Basic Information
| Provider Information | |||||||||
| NPI: | 1598882888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRALY | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1701 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764301701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254371184 | ||||||||
| FaxNumber: | 3254373314 | ||||||||
| Practice Location | |||||||||
| Address1: | 2617 ANTILLEY RD | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796065109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254371184 | ||||||||
| FaxNumber: | 3254373314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1144167 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.