Provider Demographics
NPI:1790964716
Name:BRUNIERA, WHITNEY LEE (PT)
Entity Type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:LEE
Last Name:BRUNIERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:BROOKE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1077 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2073
Mailing Address - Country:US
Mailing Address - Phone:706-752-1667
Mailing Address - Fax:
Practice Address - Street 1:1077 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:706-752-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52342251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic