Provider Demographics
NPI:1922475383
Name:NIQUETTE, BRIANNA (DPT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:NIQUETTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PELICAN ISLAND PL
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6962
Mailing Address - Country:US
Mailing Address - Phone:201-704-8937
Mailing Address - Fax:
Practice Address - Street 1:800 VIRGINIA AVE STE 148
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5829
Practice Address - Country:US
Practice Address - Phone:772-464-6424
Practice Address - Fax:724-644-3247
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist