Basic Information
Provider Information
NPI: 1649562661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LABELLA
FirstName: BRIANNE
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14287 N 87TH ST STE 220
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852603698
CountryCode: US
TelephoneNumber: 4805514966
FaxNumber:  
Practice Location
Address1: 10325 E RIGGS RD STE 102
Address2:  
City: SUN LAKES
State: AZ
PostalCode: 852487647
CountryCode: US
TelephoneNumber: 2037622900
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/10/2011
LastUpdateDate: 10/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home