Provider Demographics
NPI:1306394424
Name:BRAZILL, BRITTANY LEE (RPT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEE
Last Name:BRAZILL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:STE 40
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist