Healthcare Provider Details

I. General information

NPI: 1497581060
Provider Name (Legal Business Name): BRIANA WINTNER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 5TH AVE
SAN RAFAEL CA
94901-1808
US

IV. Provider business mailing address

650 BEGONIA ST
ESCONDIDO CA
92027-2015
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-7170
  • Fax:
Mailing address:
  • Phone: 760-594-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT306584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: