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General NPI Number Information
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NPI Number | 1023100641
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Entity Type | Individual
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Provider Name | DONIELLE LYNN BRASURE MPT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 232 ATLANTIC AVE
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City | MILLVILLE
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State | DE
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Zip | 19967-6728
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Country | US
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Telephone | 302-539-3110
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Fax | 302-539-7237
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Provider Business Mailing Address
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Address Line | 232 ATLANTIC AVE
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City | MILLVILLE
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State | DE
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Zip | 19967-6728
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Country | US
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Telephone | 302-539-3110
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Fax | 302-539-7237
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J10001969
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License Number State | DE
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