Individual
BRITTANY BIANCA BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2531 OLD ROSEBUD RD, LEXINGTON, KY 40509-4574
(859) 554-1619
Mailing address
2689 BRADEN WAY APT 44-2689, LEXINGTON, KY 40509-8571
(606) 276-7685
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007704
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KYHAN5746431
ANTHEM BLUECROSS BLUESHIELD
KY
Enumeration date
08/09/2019
Last updated
08/09/2019
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