Healthcare Provider Details

I. General information

NPI: 1023100641
Provider Name (Legal Business Name): DONIELLE LYNN BRASURE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ATLANTIC AVE
MILLVILLE DE
19967-6728
US

IV. Provider business mailing address

232 ATLANTIC AVE
MILLVILLE DE
19967-6728
US

V. Phone/Fax

Practice location:
  • Phone: 302-539-3110
  • Fax: 302-539-7237
Mailing address:
  • Phone: 302-539-3110
  • Fax: 302-539-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10001969
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: