Provider Demographics
NPI:1194439828
Name:CLAUSER, BREANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CLAUSER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:M
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:480-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:15905 S 46TH ST STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-2206
Practice Address - Country:US
Practice Address - Phone:480-805-8304
Practice Address - Fax:480-805-8304
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist