Provider Demographics
NPI:1649491341
Name:HILL, BRIAN ALEXANDER (PTA, ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:HILL
Suffix:
Gender:M
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MOUNT VERNON WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8381
Mailing Address - Country:US
Mailing Address - Phone:714-524-3500
Mailing Address - Fax:714-524-0366
Practice Address - Street 1:1075 YORBA PL
Practice Address - Street 2:SUITE 107
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3152
Practice Address - Country:US
Practice Address - Phone:714-524-3500
Practice Address - Fax:714-524-0366
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3702225200000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer