Provider Demographics
NPI:1063568244
Name:BRUBAKER, PATRICIA DAWN (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DAWN
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5457
Mailing Address - Country:US
Mailing Address - Phone:928-428-5243
Mailing Address - Fax:
Practice Address - Street 1:688 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5457
Practice Address - Country:US
Practice Address - Phone:928-428-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist