Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10426 | AZ |
N | 2251P0200X | Physical Therapist - Pediatrics | 10426 | AZ |
NPI | 1093148892 |
---|---|
Provider Name | Brittany Dichraff |
First Address | Mesa, AZ 85206-2148 |
Second Address | Mesa, AZ 85206-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 15/08/2013 |