Provider Demographics
NPI:1508001165
Name:BRUSHWYLER, ELIZABETH DOROTHY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DOROTHY
Last Name:BRUSHWYLER
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 1:3601 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5309
Mailing Address - Country:US
Mailing Address - Phone:916-481-1300
Mailing Address - Fax:916-979-1578
Practice Address - Street 1:3601 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5309
Practice Address - Country:US
Practice Address - Phone:916-481-1300
Practice Address - Fax:916-979-1578
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22487225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics