Provider Demographics
NPI:1295457836
Name:DEBROUGH, MARLEENA ANN
Entity type:Individual
Prefix:
First Name:MARLEENA
Middle Name:ANN
Last Name:DEBROUGH
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 1:2483 DRAGON CIR
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5103
Mailing Address - Country:US
Mailing Address - Phone:757-724-1630
Mailing Address - Fax:
Practice Address - Street 1:600 PAOLI POINTE DR
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-2104
Practice Address - Country:US
Practice Address - Phone:610-296-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202665225100000X
PAPT030299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist