Individual
BRITTANY B MYCZKOWSKI
Active
Individual
BRITTANY B MYCZKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
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
Update your record
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