Provider Demographics
NPI:1386856623
Name:TORTORELLA, BRIAN (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:TORTORELLA
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41408 N HUDSON TRL
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3746
Mailing Address - Country:US
Mailing Address - Phone:623-297-2386
Mailing Address - Fax:623-551-7802
Practice Address - Street 1:41408 N HUDSON TRL
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3746
Practice Address - Country:US
Practice Address - Phone:623-297-2386
Practice Address - Fax:623-551-7802
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist