Provider Demographics
NPI:1003933433
Name:BRANDT, LIBBY ELAINE (PT)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:ELAINE
Last Name:BRANDT
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 1:15150 HARDSCRABBLE RD
Mailing Address - Street 2:BOX 746
Mailing Address - City:ARIVACA
Mailing Address - State:AZ
Mailing Address - Zip Code:85601
Mailing Address - Country:US
Mailing Address - Phone:520-398-8257
Mailing Address - Fax:
Practice Address - Street 1:2830 E BROWN RD STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5431
Practice Address - Country:US
Practice Address - Phone:602-875-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist