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NPI Code Detail

MEDICARE: BREANNA VIKANDER PHYSICAL THERAPY, P.C.

MEDICARE: BREANNA VIKANDER PHYSICAL THERAPY, P.C.
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
1111N00000XChiropractor

General Provider Information

NPI Number : 1144869058
Entity Type Code : Organization
Provider Name (Legal Business Name) : BREANNA VIKANDER PHYSICAL THERAPY, P.C.
Provider Business Mailing Address
First Line : PO BOX 549
Second Line :
City : CHANHASSEN
State : MN
Zip : 55317-0549
Country : US
Telephone Number : 952-229-7464
Fax Number :
Provider Business Practice Location Address
First Line : 25600 RANCHO NIGUEL RD
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-7303
Country : US
Telephone Number : 952-229-7464
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : REZA ALIZADEH
Credential : DC
Telephone Number : 612-868-6894
Provider Enumeration Date : 12/26/2019
Last Update Date : 12/26/2019

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Directions to “BREANNA VIKANDER PHYSICAL THERAPY, P.C. ” Practice Location

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