Provider Demographics
NPI:1750863023
Name:INTERLICHIA, BRIANNA LYNN
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
Last Name:INTERLICHIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 E HENRIETTA RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2655
Mailing Address - Country:US
Mailing Address - Phone:585-427-7610
Mailing Address - Fax:585-427-7410
Practice Address - Street 1:1057 E HENRIETTA RD STE 500
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2655
Practice Address - Country:US
Practice Address - Phone:585-427-7610
Practice Address - Fax:585-427-7410
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist