Provider Demographics
NPI:1235126293
Name:DEBO, BRETT (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:
Last Name:DEBO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1433
Mailing Address - Country:US
Mailing Address - Phone:248-814-8060
Mailing Address - Fax:248-814-8070
Practice Address - Street 1:1210 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1433
Practice Address - Country:US
Practice Address - Phone:248-814-8060
Practice Address - Fax:248-814-8070
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F31133OtherBCBS
MIN73270002Medicare PIN