Provider Demographics
NPI:1669499539
Name:BRILL, MICHELLE RENATA (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENATA
Last Name:BRILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BIDDLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3969
Mailing Address - Country:US
Mailing Address - Phone:302-376-5083
Mailing Address - Fax:
Practice Address - Street 1:300 BIDDLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3969
Practice Address - Country:US
Practice Address - Phone:302-838-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist