Provider Demographics
NPI:1114416716
Name:BRIX, MARY RUTH (MS, PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RUTH
Last Name:BRIX
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 N ROCHESTER
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6454
Mailing Address - Country:US
Mailing Address - Phone:480-332-7120
Mailing Address - Fax:
Practice Address - Street 1:4850 E BASELINE RD STE 114
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-396-2781
Practice Address - Fax:480-854-3094
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1922OtherPT LICENSE