Provider Demographics
NPI:1720251002
Name:BRANTL, JOANITA AUSTRID (LMT)
Entity Type:Individual
Prefix:
First Name:JOANITA
Middle Name:AUSTRID
Last Name:BRANTL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W MCNAIR ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1831
Mailing Address - Country:US
Mailing Address - Phone:602-316-9321
Mailing Address - Fax:
Practice Address - Street 1:641 W MCNAIR ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1831
Practice Address - Country:US
Practice Address - Phone:602-316-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-06809172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist