Provider Demographics
NPI:1013356435
Name:MCDAVID, BREANNA NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:NICOLE
Last Name:MCDAVID
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 1:1725 DUKE ST
Mailing Address - Street 2:GR04
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3456
Mailing Address - Country:US
Mailing Address - Phone:703-299-3111
Mailing Address - Fax:
Practice Address - Street 1:1725 DUKE ST
Practice Address - Street 2:GR04
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3456
Practice Address - Country:US
Practice Address - Phone:703-299-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist