Provider Demographics
NPI:1477751048
Name:BRUNETTE, JEANNE RENE (PT)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:RENE
Last Name:BRUNETTE
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 1:4557 WALNUT CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4540
Mailing Address - Country:US
Mailing Address - Phone:859-576-8343
Mailing Address - Fax:
Practice Address - Street 1:130 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2238
Practice Address - Country:US
Practice Address - Phone:859-623-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist