Provider Demographics
NPI:1184072548
Name:PITRE, BRIANNA MORGAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MORGAN
Last Name:PITRE
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 1:420 STATE ROUTE 34 STE 317
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2517
Mailing Address - Country:US
Mailing Address - Phone:732-252-6155
Mailing Address - Fax:
Practice Address - Street 1:420 STATE ROUTE 34 STE 317
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2517
Practice Address - Country:US
Practice Address - Phone:732-252-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0014477225100000X
NJ40QA01597600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX509482ZK1TMedicare PIN