Provider Demographics
NPI:1265402127
Name:BRUNETT, MARISA (MS, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:BRUNETT
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 CHESTNUT RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4341
Mailing Address - Country:US
Mailing Address - Phone:321-229-5941
Mailing Address - Fax:407-365-9168
Practice Address - Street 1:3403 TECHNOLOGICAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1476
Practice Address - Country:US
Practice Address - Phone:407-681-2520
Practice Address - Fax:407-681-2521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL#1512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer