Provider Demographics
NPI:1659519700
Name:BRIERE, ELIZABETH A (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BRIERE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 W ACOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-505-3347
Mailing Address - Fax:928-453-1836
Practice Address - Street 1:1977 ACOMA BLVD W
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-2958
Practice Address - Country:US
Practice Address - Phone:928-854-7668
Practice Address - Fax:928-854-7668
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5945282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural