Provider Demographics
NPI:1205345915
Name:PANNELL, BRITNEE MAZELLE (DPT)
Entity type:Individual
Prefix:
First Name:BRITNEE
Middle Name:MAZELLE
Last Name:PANNELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 ALYSHEBA WAY STE 3202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2280
Mailing Address - Country:US
Mailing Address - Phone:859-265-8868
Mailing Address - Fax:859-264-8878
Practice Address - Street 1:3840 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1708
Practice Address - Country:US
Practice Address - Phone:604-832-4222
Practice Address - Fax:260-483-0788
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012668A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist