Provider Demographics
NPI:1477988723
Name:DUVENDECK, BREANNE M (DPT)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:M
Last Name:DUVENDECK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:M
Other - Last Name:ZAREMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33200 W 14 MILE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3587
Mailing Address - Country:US
Mailing Address - Phone:248-538-7607
Mailing Address - Fax:248-538-7623
Practice Address - Street 1:33200 W 14 MILE RD STE 160
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3587
Practice Address - Country:US
Practice Address - Phone:248-538-7607
Practice Address - Fax:248-538-7623
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020253225100000X
MI5501018276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist