Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 10328 | AZ |
NPI | 1043659659 |
---|---|
Provider Name | Amber Brennan |
First Address | Tempe, AZ 85282-2667 |
Second Address | Mesa, AZ 85207-5114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 17/06/2013 |