Provider Demographics
NPI:1386083509
Name:RONNEBAUM, BRITTANY (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:RONNEBAUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8355 LAGUNILLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4730
Mailing Address - Country:US
Mailing Address - Phone:702-580-8125
Mailing Address - Fax:
Practice Address - Street 1:4215 S GRAND CANYON DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7173
Practice Address - Country:US
Practice Address - Phone:702-448-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist