Individual provider Active NPI

Brianne Haley, DPT

  • Physical Therapist
  • Longview, TX
National Provider Identifier
1659741098
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1261611 Issued in TX
Practice address
2903 Judson Rd
Longview, TX 75605-1803
Phone
(903) 663-6332
Fax
(903) 663-6347
NPI assigned
Sep 28, 2015
Last updated
Dec 20, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1261611 TX Primary

Addresses

Primary practice location

2903 Judson Rd
Longview, TX 75605-1803

Mailing address

2903 Judson Rd
Longview, TX 75605-1803
Phone (903) 663-6332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170208000915 TX Practitioner - Physical Therapist in Private Practice 6103108493 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ak Fitness Health Center Inc.Group PAC ID 6800926684, 2 clinicians

Practice addresses (Care Compare)

2903 Judson Rd
Longview, TX 75605-1803
Phone (903) 663-6332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1261611TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ak Fitness Health Center Inc. Physical Therapist CurrentSince Aug 1, 2016 Accepting new patients
A K Fitness Therapy Center Past Accepting new patients

Locations

2903 Judson Rd
Longview, TX 75605
Phone (903) 235-5468

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1659741098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 JUDSON RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756051803",
            "telephone_number": "903-663-6332",
            "fax_number": "903-663-6347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2903 JUDSON RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756051803",
            "telephone_number": "903-663-6332",
            "fax_number": "903-663-6347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALEY",
        "first_name": "BRIANNE",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1261611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.