Provider Demographics
NPI:1780838607
Name:PACHECO, BRYNILLA (PT)
Entity Type:Individual
Prefix:
First Name:BRYNILLA
Middle Name:
Last Name:PACHECO
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-0606
Mailing Address - Country:US
Mailing Address - Phone:818-955-5786
Mailing Address - Fax:818-955-5789
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:STE 325
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-955-5786
Practice Address - Fax:818-955-5789
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30424225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist