Provider Demographics
NPI:1528312154
Name:WILLENBRECHT, JEFFREY RYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RYAN
Last Name:WILLENBRECHT
Suffix:
Gender:M
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 1:8420 W WARM SPRINGS RD # 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3624
Mailing Address - Country:US
Mailing Address - Phone:702-260-6238
Mailing Address - Fax:702-263-6530
Practice Address - Street 1:13951 W GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2436
Practice Address - Country:US
Practice Address - Phone:623-537-9730
Practice Address - Fax:623-537-9871
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2770225100000X
AZLPT-010749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist