Provider Demographics
NPI:1689996852
Name:LEBRUN, MARCIE RACHELE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:RACHELE
Last Name:LEBRUN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:RACHELE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3620 CARAMEL AVE
Mailing Address - Street 2:#69
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6606
Mailing Address - Country:US
Mailing Address - Phone:386-767-9265
Mailing Address - Fax:
Practice Address - Street 1:3620 CARAMEL AVE
Practice Address - Street 2:#69
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6606
Practice Address - Country:US
Practice Address - Phone:386-767-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 48086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist