MEDICARE: BREANNE JEAN TUOHY PT, 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	31013	AZ

General Provider Information

NPI Number	:	1972133486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNE JEAN TUOHY PT, DPT

Provider Business Mailing Address
First Line	:	9680 W NORTHERN AVE UNIT 1317
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-4650
Country	:	US
Telephone Number	:	914-364-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-1302
Country	:	US
Telephone Number	:	623-219-4242
Fax Number	:

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

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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