Provider Demographics
NPI:1558871269
Name:BRISBY, DANA SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SUZANNE
Last Name:BRISBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:SUZANNE
Other - Last Name:KUJAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6367 E TANQUE VERDE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3915
Mailing Address - Country:US
Mailing Address - Phone:520-296-2900
Mailing Address - Fax:520-296-3800
Practice Address - Street 1:6367 E TANQUE VERDE RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3915
Practice Address - Country:US
Practice Address - Phone:520-296-2900
Practice Address - Fax:520-296-3800
Is Sole Proprietor?:No
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist