Provider Demographics
NPI:1225547904
Name:VANNUCCI, BRIANNE CHRISTINE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:CHRISTINE
Last Name:VANNUCCI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:BRIANNE
Other - Middle Name:CHRISTINE
Other - Last Name:HATHERILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2823 S LYNCH
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2185
Mailing Address - Country:US
Mailing Address - Phone:602-686-0886
Mailing Address - Fax:
Practice Address - Street 1:1551 E ELLIOT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-7002
Practice Address - Country:US
Practice Address - Phone:602-686-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293769225100000X
AZ30615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist