Provider Demographics
NPI:1861892713
Name:CALLISON, BRIANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:CALLISON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:CAPERONIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11 EAGLE ROCK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:637 WYCKOFF AVE STE 25
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1442
Practice Address - Country:US
Practice Address - Phone:201-848-4599
Practice Address - Fax:201-848-6336
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01564600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist