Provider Demographics
NPI:1679189526
Name:AMBROZ, BRYNNE (PTA)
Entity Type:Individual
Prefix:
First Name:BRYNNE
Middle Name:
Last Name:AMBROZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRYNNE
Other - Middle Name:
Other - Last Name:RETZLAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1300 GYM CT
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-5001
Mailing Address - Country:US
Mailing Address - Phone:507-276-3539
Mailing Address - Fax:
Practice Address - Street 1:4401 EGAN DR
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2024
Practice Address - Country:US
Practice Address - Phone:952-746-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2087225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant