MEDICARE: BRIEANNA NICOLE STURGIS DPT

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
1	225100000X	Physical Therapist	PT015683	GA

General Provider Information

NPI Number	:	1265190334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIEANNA NICOLE STURGIS DPT

Provider Business Mailing Address
First Line	:	1609 WOODHILL TRL
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2664
Country	:	US
Telephone Number	:	706-631-2101
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 N LOUISVILLE ST
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-6012
Country	:	US
Telephone Number	:	706-986-0996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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