Provider Demographics
NPI:1265190334
Name:STURGIS, BRIEANNA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:NICOLE
Last Name:STURGIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 WOODHILL TRL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2664
Mailing Address - Country:US
Mailing Address - Phone:706-631-2101
Mailing Address - Fax:
Practice Address - Street 1:250 N LOUISVILLE ST
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:GA
Practice Address - Zip Code:30814-6012
Practice Address - Country:US
Practice Address - Phone:706-986-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist