Provider Demographics
NPI:1639611742
Name:BACKOFEN, BRITTANY WINCIA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:WINCIA
Last Name:BACKOFEN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 ANNIE OAKLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4526
Mailing Address - Country:US
Mailing Address - Phone:702-799-7580
Mailing Address - Fax:
Practice Address - Street 1:3850 ANNIE OAKLEY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4526
Practice Address - Country:US
Practice Address - Phone:702-799-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer