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General NPI Number Information
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NPI Number | 1881318871
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Entity Type | Individual
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Provider Name | BROOKE ANNALYNN BECHTOLD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 2155 POST OAK TRITT RD STE 400
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City | MARIETTA
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State | GA
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Zip | 30062-1651
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Country | US
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Telephone | 678-401-2952
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Fax |
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Provider Business Mailing Address
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Address Line | 16953 172ND AVE SE
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City | BIG LAKE
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State | MN
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Zip | 55309-4582
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Country | US
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Telephone | 763-688-0009
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | A2556
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License Number State | MN
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