Provider Demographics
NPI:1891733515
Name:BRUNET, MICHEL G (PT)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:G
Last Name:BRUNET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1340
Mailing Address - Country:US
Mailing Address - Phone:207-839-5860
Mailing Address - Fax:207-839-2499
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1340
Practice Address - Country:US
Practice Address - Phone:207-839-5860
Practice Address - Fax:207-839-2499
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7651Medicare ID - Type Unspecified