Provider Demographics
NPI:1710641725
Name:GLOMBOWSKI, BRIANNE
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:GLOMBOWSKI
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 1:2545 N OPDYKE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1970
Mailing Address - Country:US
Mailing Address - Phone:248-780-2550
Mailing Address - Fax:248-780-2551
Practice Address - Street 1:2545 N OPDYKE RD STE 106
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1970
Practice Address - Country:US
Practice Address - Phone:248-780-2550
Practice Address - Fax:248-780-2551
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant