Provider Demographics
NPI:1932608007
Name:RYAN, BROOKE LEAH (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEAH
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LEAH
Other - Last Name:LANDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2928 DANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1516
Mailing Address - Country:US
Mailing Address - Phone:682-554-7898
Mailing Address - Fax:
Practice Address - Street 1:11661 PRESTON RD STE 173
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6182
Practice Address - Country:US
Practice Address - Phone:214-265-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1302151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist