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Individual

BRITTANY B MYCZKOWSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT

Contact information

Practice address
2182 GALLATIN PIKE N, MADISON, TN 37115-2004
(615) 859-7775
(615) 859-7772
Mailing address
PO BOX 681478, FRANKLIN, TN 37068-1478
(615) 591-6590
(615) 591-6601

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10212
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1376958538
MEDICAID QMB ONLY INDIVIDUAL PROVIDER ID
VA
01
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
06/26/2014
Last updated
05/02/2017
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