Provider Demographics
NPI:1538484928
Name:PHEBUS, BRITTANY NICOLE
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:NICOLE
Last Name:PHEBUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:NICOLE
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18825 STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-8316
Mailing Address - Country:US
Mailing Address - Phone:217-549-2728
Mailing Address - Fax:217-345-0910
Practice Address - Street 1:18825 STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-8316
Practice Address - Country:US
Practice Address - Phone:217-549-2728
Practice Address - Fax:217-345-0910
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist