Provider Demographics
NPI:1265797344
Name:BRASHEARS-BUTLER, DEBORAH RENE (PTA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RENE
Last Name:BRASHEARS-BUTLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BRASHEARS-BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1602 SW MULLINAX AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 SE PALM BEACH RD
Practice Address - Street 2:STUART NURSING AND RESTORATIVE CARE
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4044
Practice Address - Country:US
Practice Address - Phone:772-283-5887
Practice Address - Fax:772-781-4563
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA196314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility