Provider Demographics
NPI:1225383433
Name:BROUSALINSKI, GELENA (PT)
Entity Type:Individual
Prefix:MRS
First Name:GELENA
Middle Name:
Last Name:BROUSALINSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685D BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2513
Mailing Address - Country:US
Mailing Address - Phone:267-231-2395
Mailing Address - Fax:215-607-7600
Practice Address - Street 1:11685D BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2513
Practice Address - Country:US
Practice Address - Phone:267-231-2395
Practice Address - Fax:215-607-7600
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006971L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist