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General NPI Number Information
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NPI Number | 1063846988
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Entity Type | Individual
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Provider Name | BRIANA CONN PTA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 333 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4356
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Country | US
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Telephone | 201-568-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 5157 ELVENA AVE
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-1764
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Country | US
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Telephone | 609-320-0186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00299800
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License Number State | NJ
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