Provider Demographics
NPI:1346412384
Name:BRANNON, AMY MICHELLE (PT, DPT, FAAOMPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:PT, DPT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 N 16TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3282
Mailing Address - Country:US
Mailing Address - Phone:602-826-0037
Mailing Address - Fax:480-275-6310
Practice Address - Street 1:5353 N 16TH ST STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3282
Practice Address - Country:US
Practice Address - Phone:602-826-0037
Practice Address - Fax:480-275-6310
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist