Provider Demographics
NPI:1346720034
Name:DEAVILA, BRITTANY MICHELLE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MICHELLE
Last Name:DEAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14182 CHARLES POLLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-3196
Mailing Address - Country:US
Mailing Address - Phone:915-637-4639
Mailing Address - Fax:
Practice Address - Street 1:10350 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1602
Practice Address - Country:US
Practice Address - Phone:915-595-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2124538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant