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NPI Code Detail

MEDICARE: MRS. BRANDIE P. LIEBLONG PT

MEDICARE: MRS. BRANDIE P. LIEBLONG PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2132AR

General Provider Information

NPI Number : 1114063138
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRANDIE P. LIEBLONG PT
Provider Business Mailing Address
First Line : 3507 WOODSPRINGS RD
Second Line :
City : JONESBORO
State : AR
Zip : 72404-6808
Country : US
Telephone Number : 870-931-1818
Fax Number :
Provider Business Practice Location Address
First Line : 806 GLENDALE ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-4455
Country : US
Telephone Number : 870-933-9528
Fax Number : 870-933-9778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 07/08/2007

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