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General NPI Number Information
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NPI Number | 1356984983
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Entity Type | Organization
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Legal Business Name | BROOKLAND WELLNESS GROUP PLLC
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Dates
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Enumeration Date | 10/27/2019
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Last Update Date | 10/27/2019
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Provider Practice Location Address
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Address Line | 676 KENNETH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-1420
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Country | US
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Telephone | 814-657-4515
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Fax |
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Provider Business Mailing Address
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Address Line | 676 KENNETH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-1420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BREANNE CONDON
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Credential | PT, DPT
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Telephone | 814-657-4515
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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 |
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License Number State |
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