Provider Demographics
NPI:1255639894
Name:BRZOTICKY, JANICE SKINNER (AAS, BAS)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:SKINNER
Last Name:BRZOTICKY
Suffix:
Gender:F
Credentials:AAS, BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BRIDGE CREEK LN
Mailing Address - Street 2:P.O. BOX 156
Mailing Address - City:WOLF CREEK
Mailing Address - State:MT
Mailing Address - Zip Code:59648-8702
Mailing Address - Country:US
Mailing Address - Phone:406-431-0476
Mailing Address - Fax:
Practice Address - Street 1:1401 25TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5183
Practice Address - Country:US
Practice Address - Phone:406-731-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant