Provider Demographics
NPI:1003163205
Name:BROWN, BRITTANY RENAE (DPT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RENAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:RENAE
Other - Last Name:MCCORKHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:561 WAYSIDE PLZ
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-3830
Mailing Address - Country:US
Mailing Address - Phone:951-756-3745
Mailing Address - Fax:
Practice Address - Street 1:1615 CURLEW DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4718
Practice Address - Country:US
Practice Address - Phone:208-516-1204
Practice Address - Fax:208-577-6477
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9959225100000X
ID6787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ736884Medicaid
Z91071Medicare PIN