Deanna Brocard
Individual provider Active NPI Physical Therapy Assistant · Fort Mohave, AZ
NPI 1447590211 · NPPES record last updated Feb 15, 2013
Key facts
- NPI
- 1447590211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 9364A (AZ)
- Practice address
- 2112 E Desert Lakes Dr
Fort Mohave, AZ 86426-6812 - Phone
- (562) 822-1198
- NPI assigned
- Feb 15, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9364A | AZ | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 9364A | AZ | Yes |
Addresses
Primary practice location
2112 E Desert Lakes Dr
Fort Mohave, AZ 86426-6812
Mailing address
2112 E Desert Lakes Dr
Fort Mohave, AZ 86426-6812
Other providers in Fort Mohave, AZ
- Jennifer Booze-Hawkes
- Eric Eugene Borofsky
- Larry Lee Bousquet II
- Clifford J Bragg
- Melissa Jones Brewer Larson
- Hector Burgara Jr.
- Kelly T. Buth
- Mikala Lin Byers
- Dilyara Cannon
- Capstone Medical Arizona, LLC
All providers in Fort Mohave, AZ · Physical Therapy Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.