Healthcare Provider Details

I. General information

NPI: 1528181765
Provider Name (Legal Business Name): NANCY ELLEN BRILEY R.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD SUITE 330
GRANADA HILLS CA
91344-6342
US

IV. Provider business mailing address

28423 APPLEWOOD LN
CASTAIC CA
91384-4301
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-7304
  • Fax: 818-832-7249
Mailing address:
  • Phone: 661-257-2698
  • Fax: 661-257-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: