Provider Demographics
NPI:1992294136
Name:PIEPENBROK, BRIANNA LAVONNE (DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LAVONNE
Last Name:PIEPENBROK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2607
Mailing Address - Country:US
Mailing Address - Phone:715-574-4999
Mailing Address - Fax:
Practice Address - Street 1:750 N ESTRELLA PKWY STE 50
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9279
Practice Address - Country:US
Practice Address - Phone:623-882-2992
Practice Address - Fax:623-925-4923
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2255A2300X
AZ31864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer