Provider Demographics
NPI:1730333907
Name:SLUSARENKO, BRIANNE (PT)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:SLUSARENKO
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 1:265 N EUCLID AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1594
Mailing Address - Country:US
Mailing Address - Phone:626-356-4948
Mailing Address - Fax:
Practice Address - Street 1:265 N EUCLID AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1594
Practice Address - Country:US
Practice Address - Phone:626-356-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist