Individual
BRETT QUALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
191 SWANSON AVE, #102, LAKE HAVASU CITY, AZ 86403-6699
(928) 855-7880
(928) 855-7881
Mailing address
191 SWANSON AVE, #102, LAKE HAVASU CITY, AZ 86403-6699
(928) 855-7880
(928) 855-7881
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2594
NV
225100000X
Physical Therapist
34485
CA
225100000X
Physical Therapist
Primary
9575
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2594
NV LICENSE
NV
01
—
34485
CA LICENSE
CA
01
—
9575
ARIZONA LICENSE
AZ
Enumeration date
02/19/2008
Last updated
03/25/2017
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