Provider Demographics
NPI:1639718430
Name:DELEMARRE-BRAND, ANNELISE (PT)
Entity Type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:DELEMARRE-BRAND
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 1:350 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1574
Mailing Address - Country:US
Mailing Address - Phone:631-553-5578
Mailing Address - Fax:
Practice Address - Street 1:1800 WALT WHITMAN RD STE 120
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3237
Practice Address - Country:US
Practice Address - Phone:631-694-0005
Practice Address - Fax:631-694-0007
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist