Provider Demographics
NPI:1063951788
Name:FOREMAN, BRIANNA DOREEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DOREEN
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 E COAST HWY
Mailing Address - Street 2:STE 206
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2108
Mailing Address - Country:US
Mailing Address - Phone:949-675-2922
Mailing Address - Fax:
Practice Address - Street 1:2711 E COAST HWY
Practice Address - Street 2:STE 206
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2108
Practice Address - Country:US
Practice Address - Phone:949-675-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist