Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | ||
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1013495621 |
---|---|
Provider Name | Hannah Breck |
First Address | Scottsdale, AZ 85260-3045 |
Second Address | Phoenix, AZ 85050-4605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |