Individual
MR. DUSTIN RAY BRISCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2120 AIRWAY AVENUE, KINGMAN, AZ 86409-3027
(928) 757-1211
(928) 757-8826
Mailing address
2120 AIRWAY AVENUE, KINGMAN, AZ 86409-3027
(928) 757-1211
(928) 757-8826
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5607
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
755217
—
AZ
Enumeration date
10/24/2006
Last updated
12/05/2008
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