Provider Demographics
NPI:1629304928
Name:BRILL, BRANDI N (PT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:N
Last Name:BRILL
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 1:4660 STATE ROUTE 51 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4305
Mailing Address - Country:US
Mailing Address - Phone:724-379-6282
Mailing Address - Fax:724-379-6285
Practice Address - Street 1:1008 TAVERN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2801
Practice Address - Country:US
Practice Address - Phone:304-264-4040
Practice Address - Fax:304-264-4041
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 002889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist