Provider Demographics
NPI:1679883367
Name:BRUNSWICK, ANNETTE KAY (LPTA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:KAY
Last Name:BRUNSWICK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1761
Mailing Address - Country:US
Mailing Address - Phone:419-678-8527
Mailing Address - Fax:
Practice Address - Street 1:1096 N OHIO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2919
Practice Address - Country:US
Practice Address - Phone:937-548-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06166225200000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No172V00000XOther Service ProvidersCommunity Health Worker