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General NPI Number Information
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NPI Number | 1780093252
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Entity Type | Individual
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Provider Name | EMILY BRUSHABER
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Gender | Female
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 5405 LANCASTER HILLS DR 42
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City | CLARKSTON
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State | MI
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Zip | 48346-4426
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Country | US
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Telephone | 248-622-7990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1822
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City | CLARKSTON
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State | MI
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Zip | 48346
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Country | US
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Telephone | 248-622-7990
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06004861A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502002630
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License Number State | MI
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