Provider Demographics
NPI:1073756425
Name:BRISSETT, JEANETTE ELAINE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ELAINE
Last Name:BRISSETT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 ALDORO TER
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3301
Mailing Address - Country:US
Mailing Address - Phone:386-748-5037
Mailing Address - Fax:
Practice Address - Street 1:2031 ALDORO TER
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3301
Practice Address - Country:US
Practice Address - Phone:386-748-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21341225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant