Provider Demographics
NPI:1972133486
Name:TUOHY, BREANNE JEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:JEAN
Last Name:TUOHY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9680 W NORTHERN AVE UNIT 1317
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-4650
Mailing Address - Country:US
Mailing Address - Phone:914-364-0651
Mailing Address - Fax:
Practice Address - Street 1:5810 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1302
Practice Address - Country:US
Practice Address - Phone:623-219-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist