Provider Demographics
NPI:1508135427
Name:EBY, BRIANNA M (PT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:M
Last Name:EBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:M
Other - Last Name:SCHLICHTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, OCS
Mailing Address - Street 1:1821 S STOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2257
Mailing Address - Country:US
Mailing Address - Phone:608-260-6000
Mailing Address - Fax:608-260-6906
Practice Address - Street 1:1821 S STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-2257
Practice Address - Country:US
Practice Address - Phone:608-260-6000
Practice Address - Fax:608-260-6906
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004934225100000X
WI13758225100000X
NCP17875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist