Healthcare Provider Details

I. General information

NPI: 1447141155
Provider Name (Legal Business Name): BRIANNE WICKLAND DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 MAJOR ST STE 107
LOS ANGELES CA
90230-6356
US

IV. Provider business mailing address

11405 CHANDLER BLVD UNIT 703
NORTH HOLLYWOOD CA
91601-2698
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT308275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: