Healthcare Provider Details

I. General information

NPI: 1912483710
Provider Name (Legal Business Name): BRITTANY NICHOLE TOSI ATC, CES, PES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY NICHOLE DIETER

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W GUADALUPE RD
MESA AZ
85202-7575
US

IV. Provider business mailing address

15002 N 33RD PL
PHOENIX AZ
85032-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-3000
  • Fax:
Mailing address:
  • Phone: 520-440-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1316
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: