Provider Demographics
NPI:1477767143
Name:BRUNELL, HEATHER LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:BRUNELL
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 1:22 ESOPUS DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4053
Mailing Address - Country:US
Mailing Address - Phone:518-383-3375
Mailing Address - Fax:
Practice Address - Street 1:2256 BURDETT AVE
Practice Address - Street 2:EDDY MEMORIAL GERIATRIC CENTER
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2400
Practice Address - Country:US
Practice Address - Phone:518-271-5927
Practice Address - Fax:518-274-5407
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021303-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist