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General NPI Number Information
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NPI Number | 1669035002
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Entity Type | Individual
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Provider Name | BREANNA MAREE DUSO DPT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1991 FORDHAM DR STE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3774
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Country | US
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Telephone | 910-484-4653
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Fax | 910-483-9256
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Provider Business Mailing Address
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Address Line | 1991 FORDHAM DR STE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3774
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Country | US
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Telephone | 910-484-4653
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Fax | 910-483-9256
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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 | 5501019252
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 295488
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P23621
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License Number State | NC
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