Individual
BRIAN E PORTUGAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4200
AZ
Other
Enumeration date
08/12/2008
Last updated
10/12/2020
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