Provider Demographics
NPI:1609152495
Name:FELTUS, BRANDIE ALINE
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:ALINE
Last Name:FELTUS
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 1:2920 CHILLY NIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-5100
Mailing Address - Country:US
Mailing Address - Phone:310-894-2139
Mailing Address - Fax:
Practice Address - Street 1:2920 CHILLY NIGHTS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-5100
Practice Address - Country:US
Practice Address - Phone:310-894-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner