Provider Demographics
NPI:1093216228
Name:WALL, BRIEANN H (MT-BC)
Entity type:Individual
Prefix:MS
First Name:BRIEANN
Middle Name:H
Last Name:WALL
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3736
Mailing Address - Country:US
Mailing Address - Phone:267-566-6040
Mailing Address - Fax:
Practice Address - Street 1:551 E EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8321
Practice Address - Country:US
Practice Address - Phone:267-566-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty