Provider Demographics
NPI:1720351034
Name:DE BRUN, MILTON (DPT)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:DE BRUN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CHEVIOT CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4726
Mailing Address - Country:US
Mailing Address - Phone:404-797-5058
Mailing Address - Fax:
Practice Address - Street 1:525 CALICO RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:TN
Practice Address - Zip Code:37616-6631
Practice Address - Country:US
Practice Address - Phone:404-797-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004564225100000X
FL26829225100000X
TN14297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist