Provider Demographics
NPI:1619559820
Name:ESSENPREIS, BRITTANY NOEL (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:NOEL
Last Name:ESSENPREIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 NOBS RD
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-4217
Mailing Address - Country:US
Mailing Address - Phone:618-401-9489
Mailing Address - Fax:
Practice Address - Street 1:10925 NOBS RD
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-4217
Practice Address - Country:US
Practice Address - Phone:618-401-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
IL160007041208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation